Provider First Line Business Practice Location Address:
3225 UNIVERSITY BLVD S STE 104
Provider Second Line Business Practice Location Address:
CREDENTIALING DEPARTMENT
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-2757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-399-1171
Provider Business Practice Location Address Fax Number:
904-727-3550
Provider Enumeration Date:
04/27/2006