MALLORY MOODY PUTNAM

LAKELAND, FL
NPI1336493428
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: FL  PA9106745)
Enumeration Date2012-10-29
Last Update Date2017-01-30
Business Address
Mrs. MALLORY MOODY PUTNAM PA
2615 FAIRMOUNT AVE
LAKELAND, FL 33803-3159
Phone number: 863-661-3887
Mailing Address
Mrs. MALLORY MOODY PUTNAM PA
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805-4543
Phone number: 863-687-1100
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