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1265823421
JAE HWAN SONG
DAYTONA BEACH, FL
NPI
1265823421
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: FL AL3738)
Enumeration Date
2015-02-10
Last Update Date
2015-02-10
Business Address
-- JAE HWAN SONG ATC
640 DR MARY MCLEOD BETHUNE BLVD HANDFILED ATHLETIC TRAINING CENTER
DAYTONA BEACH, FL 32114-3012
Phone number: 386-481-2261
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Mailing Address
-- JAE HWAN SONG ATC
1400 HANCOCK BLVD APT 1312
DAYTONA BEACH, FL 32114-5636
Phone number: 619-886-6597
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