Organization
AMERICAN EAGLE LEESBURG MC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORY WAKE (ASSOCIATE)
(734) 418-9027
Entity
Organization
Contact information
Practice address
710 S LAKE ST, LEESBURG, FL 34748-7327
(734) 418-9027
Mailing address
3819 HAWK CREST RD, ANN ARBOR, MI 48103-4246
(734) 418-9027
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
—
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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