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Organization

HEADS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JUDY WALLER (OWNER)
(813) 495-3874
Entity
Organization

Contact information

Practice address
1001 E BAKER ST, PLANT CITY, FL 33563-3700
(918) 521-8501
Mailing address
1112 JACOB WAY, ODESSA, FL 33556-6035

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
FL

Other

Enumeration date
06/28/2017
Last updated
06/11/2019
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