Provider First Line Business Practice Location Address:
1904 GLEN LAKES CIR. N.
Provider Second Line Business Practice Location Address:
THERAPY PLAYHOUSE
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-423-0060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2009