Provider First Line Business Practice Location Address: 
BAY PINES VA HEALTHCARE SYSTEM
    Provider Second Line Business Practice Location Address: 
10000 BAY PINES BLVD
    Provider Business Practice Location Address City Name: 
ST. PETERSBURG
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33708
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
727-398-6661
    Provider Business Practice Location Address Fax Number: 
727-319-1209
    Provider Enumeration Date: 
05/03/2006