DALE EDMUND PETERSEN

MARIANNA, FL
NPI1184827693
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy224P00000X Prosthetist
(Licence: FL  PRO66)
Enumeration Date2007-06-11
Last Update Date2008-03-28
Business Address
-- DALE EDMUND PETERSEN CP
4299 3RD AVE
MARIANNA, FL 32446-2136
Phone number: 850-526-0063
Mailing Address
-- DALE EDMUND PETERSEN CP
PO BOX 430
MARIANNA, FL 32447-0430
Phone number: 850-526-0063