Individual
GREGORY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1091 OLD SOUTH DR, LAKELAND, FL 33811
(813) 846-1181
Mailing address
1091 OLD SOUTH DR, LAKELAND, FL 33811-2333
(813) 846-1181
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
09/28/2017
Last updated
07/21/2022
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