Individual
MARY LARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1807 FULTON DR, FORT PIERCE, FL 34950-3939
(772) 828-5148
(772) 429-0733
Mailing address
1807 FULTON DR, FORT PIERCE, FL 34950-3939
(772) 828-5148
(772) 429-0733
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/16/2015
Last updated
10/16/2015
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