Individual
BRANDON C CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 FAIRWAY DR, DEERFIELD BEACH, FL 33441-1814
(954) 603-7885
Mailing address
6 ROSEBERRY CIR, PORT WENTWORTH, GA 31407-5612
(850) 567-5657
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
103K00000X
FL
Other
Enumeration date
08/14/2011
Last updated
01/02/2015
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