Organization
ANCIENT CITY CHILDREN'S THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHANNIE GARCIA OTD (OWNER)
(904) 826-7886
Entity
Organization
Contact information
Practice address
367 GIANNA WAY, ST AUGUSTINE, FL 32086-3858
(904) 826-7886
Mailing address
109 S. WINTERHAWK,, SUITE 7, ST. AUGUSTINE, FL 32086
(904) 826-7886
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12653
FL
Other
Enumeration date
04/12/2011
Last updated
04/12/2011
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