Provider First Line Business Practice Location Address:
11115 E DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
C/O TAKE CARE HEALTH SYSTEM
Provider Business Practice Location Address City Name:
SEFFNER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33584-8378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-413-3081
Provider Business Practice Location Address Fax Number:
813-413-3082
Provider Enumeration Date:
01/16/2007