Organization
LICE AVENGERS OF SW FLORIDA LLC
Active
Other names
Lice Clinics of America of Southwest Florida
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY RANDOLPH (OWNER)
(608) 509-6807
Entity
Organization
Contact information
Practice address
8881 TERRENE CT STE 104, BONITA SPRINGS, FL 34135-9528
(239) 237-0757
Mailing address
8881 TERRENE CT STE 104, BONITA SPRINGS, FL 34135-9528
(239) 237-0757
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
01/31/2018
Last updated
01/31/2018
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