Provider First Line Business Practice Location Address:
146 SW ORTHOPEDIC CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32024-0672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-719-5100
Provider Business Practice Location Address Fax Number:
386-719-5101
Provider Enumeration Date:
09/11/2009