Provider First Line Business Practice Location Address:
2031 E EDGEWOOD DR
Provider Second Line Business Practice Location Address:
QUEST COUNSELING CENTER SUITE #4
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33803-3659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-655-8999
Provider Business Practice Location Address Fax Number:
863-644-5118
Provider Enumeration Date:
06/27/2006