Individual
MRS. LISA L FAULK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
14020 NE COUNTY ROAD 1471, WALDO, FL 32694-4504
(352) 468-3270
Mailing address
14020 NE COUNTY ROAD 1471, WALDO, FL 32694-4504
(352) 468-3270
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA42120
FL
Other
Enumeration date
08/19/2009
Last updated
08/19/2009
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