Organization
ROCK STAR REP INC
Active
Other names
SOUTH WALTON MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
PERRY MONTY REEVES (CEO)
(863) 513-0349
Entity
Organization
Contact information
Practice address
10065 US HIGHWAY 98 W, STE B 101, MIRAMAR BEACH, FL 32550-4924
(850) 837-8005
(850) 837-4352
Mailing address
5305 OAKWAY DR, LAKELAND, FL 33805-8584
(863) 513-0349
(863) 248-0453
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/10/2009
Last updated
04/09/2009
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