PRIMARY CARE CENTER OF PORT ORANGE
Marriage and Family Therapists at Ridgewood Ave, Daytona Beach, FL

License number
Florida ME0028054
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: MS. MICHELLE L JACKSON
Title: OFFICE MANAGER
Phone: (386) 761-0050
Address
Address
4770 S Ridgewood Ave SUITE 1, Daytona Beach, FL 32127
National Provider ID: 1295910834
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about PRIMARY CARE CENTER OF PORT ORANGE at bizstanding.com

PRIMARY CARE CENTER OF PORT ORANGE, INC

4770 Ridgewood Ave SUITE 1, Port Orange, FL 32127

Status:
Inactive
Inactive reason:
AMENDMENT
Registration:
Apr 1, 1979
Inactive since:
Dec 16, 2014
State ID:
615630
Business type:
Florida Profit Corporation
Secretary, Vice Presidents:
Jon Jackson (Treasurer, President), 4770 Ridgewood Ave, Port Orange, FL 32127 (Physical),Michelle Gunter (Secretary, Vice President)
EIN:
59-1893277

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