Provider First Line Business Practice Location Address:
3515 E FLETCHER AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY, UNIVERSITY OF SOUTH FLORIDA
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-631-7132
Provider Business Practice Location Address Fax Number:
813-974-3223
Provider Enumeration Date:
08/11/2006