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1295030195
KIMBERLY THORNTON BLAKE
SANFORD, FL
NPI
1295030195
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: FL PA9105774)
Enumeration Date
2011-01-24
Last Update Date
2011-01-24
Business Address
KIMBERLY THORNTON BLAKE PA
1401 W SEMINOLE BLVD
SANFORD, FL 32771-6743
Phone number: 800-893-9698
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Mailing Address
KIMBERLY THORNTON BLAKE PA
200 CORPORATE BLVD SUITE 201
LAFAYETTE, LA 70508-3870
Phone number: 800-893-9698
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