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Individual

AMANDA LYNN HOUSTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
110 NW WHITE OAK GLENN, LAKE CITY, FL 32055
(386) 288-4474
(386) 755-3944
Mailing address
PO BOX 381, LAKE CITY, FL 32056-0381
(386) 755-3944
(386) 755-3944

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
FL

Other

Enumeration date
10/19/2006
Last updated
07/09/2007
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