Organization
J17 PREMIER TRANSPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY MARK WATTERS (PRESIDENT)
(727) 251-8184
Entity
Organization
Contact information
Practice address
11231 LAKE LANIER DR, RIVERVIEW, FL 33569-2935
(727) 251-8184
Mailing address
11231 LAKE LANIER DR, RIVERVIEW, FL 33569-2935
(727) 251-8184
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
W362-433-59-361-0
FL
Other
Enumeration date
07/02/2014
Last updated
07/02/2014
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