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1265004899
SELMAWIT DESTA
JACKSONVILLE, FL
NPI
1265004899
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2085R0202X Radiology, Diagnostic Radiology
(Licence: MI 434849)
Enumeration Date
2021-07-13
Last Update Date
2021-07-15
Business Address
SELMAWIT DESTA
1100 CESERY BLVD
JACKSONVILLE, FL 32211-5674
Phone number: 904-551-5884
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Mailing Address
SELMAWIT DESTA
2471 BRITNEY LAKES LN
JACKSONVILLE, FL 32221-3817
Phone number: 904-610-9305
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