Provider First Line Business Practice Location Address:
200 AVENUE I NE
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH DIVISION
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
33880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-294-7062
Provider Business Practice Location Address Fax Number:
863-291-6755
Provider Enumeration Date:
07/24/2008