Provider First Line Business Practice Location Address:
900 N SWALLOWTAIL DRIVE
Provider Second Line Business Practice Location Address:
STE 107 PORT ORANGE PHYSICAL THERAPY INC
Provider Business Practice Location Address City Name:
PORT ORANGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-322-4641
Provider Business Practice Location Address Fax Number:
386-322-4677
Provider Enumeration Date:
04/20/2006