Provider First Line Business Practice Location Address:
619 SOUTH MARION AVENUE 11 FA
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-755-3016
Provider Business Practice Location Address Fax Number:
386-254-6456
Provider Enumeration Date:
09/24/2006