Individual
LETARA REYONA MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1745 WHITMAN ST, JACKSONVILLE, FL 32210-1237
(904) 424-8590
Mailing address
1745 WHITMAN ST, JACKSONVILLE, FL 32210-1237
(904) 424-8590
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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