Provider Information for 1841625795
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CHRISTINA MALLORY
Sex: Female
NPI: 1841625795
Last Updated: 2013-09-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1841625795 | ||||||||
| Enumeration Date | 2013-09-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1524 WALNUT CREEK DR FLEMING ISLAND, FL 32003-7424 United States Phone: 904-505-0193 | Fax: | ||||||||
| Primary Practice Address | 4595 LEXINGTON AVE JACKSONVILLE, FL 32210-2058 United States Phone: 904-448-4700 | Fax: | ||||||||
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