ELLEN Z PROUTY
Medical Practice at Santa Rosa Blvd, Fort Walton Beach, FL

License number

Florida 14063

Issued Date

Dec 14, 1979

Effective Date

Jul 29, 1998

Expiration Date

Jun 30, 1996

Category

Health Care

Type

Clinical Laboratory Personnel

Address

Address

940 Santa Rosa Blvd APT 2426, Fort Walton Beach, FL 32548

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