Individual
EIRC MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12276 SAN JOSE BLVD, JACKSONVILLE, FL 32223-8628
(904) 886-3228
Mailing address
12276 SAN JOSE BLVD, JACKSONVILLE, FL 32223-8628
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
200984754
FL
Other
Enumeration date
05/23/2016
Last updated
05/23/2016
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