Provider First Line Business Practice Location Address:
1401 E FOWLER AVE
Provider Second Line Business Practice Location Address:
HEALTHY FAMILIES PROGR
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-558-1077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2010