Organization
FOUNTAIN LIFE ORLANDO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA WOO (DIRECTOR OF CLINICAL OPERATIONS)
(407) 725-1516
Entity
Organization
Contact information
Practice address
6424 ALEXANDRA LOUISE DR STE 120, ORLANDO, FL 32827-5812
(917) 810-8672
Mailing address
6424 ALEXANDRA LOUISE DR STE 120, ORLANDO, FL 32827-5812
(917) 810-8672
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
07/21/2023
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