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Organization

MEDSPORTS PROMASSAGE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MONIQUE COLEMAN HAMID LMT (OWNER)
(904) 505-0575
Entity
Organization

Contact information

Practice address
3491 PALL MALL DR, SUITE 104, JACKSONVILLE, FL 32257-5449
(904) 505-0575
Mailing address
PO BOX 8565, FLEMING ISLAND, FL 32006-0014
(904) 505-0575

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
MA36322
FL

Other

Enumeration date
04/02/2012
Last updated
04/02/2012
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