Provider First Line Business Practice Location Address:
1105 E KENNEDY BLVD
Provider Second Line Business Practice Location Address:
SCC DENTAL CLINIC - HCHD
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33602-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-397-6186
Provider Business Practice Location Address Fax Number:
813-273-3721
Provider Enumeration Date:
10/29/2007