Individual
MS. MARY LOU CLIME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
704 MAGNOLIA ST, NEW SMYRNA BEACH, FL 32168-7438
(386) 409-3486
Mailing address
704 MAGNOLIA ST, NEW SMYRNA BEACH, FL 32168-7438
(386) 409-3486
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230395700
—
FL
Enumeration date
04/23/2008
Last updated
04/23/2008
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