Most Relevant Information
Provider Data
| NPI Number: | 1003369190 |
| Provider Name: | DAVID LANCE HENDERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 372600000X |
| Specialty: | Adult Companion |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/26/2016 |
| Last Updated: | 07/26/2016 |
Provider Practice Location
91 BAY BRIDGE DR
GULF BREEZE
FL
325614468
Practice Location Phone/Fax
| Phone: | 8504189890 |
| Fax: |
Provider Mailing Location
6569 CODELL ST
NAVARRE
FL
325668128
Provider Mailing Phone/Fax
| Phone: | 8502408578 |
| Fax: |