Provider First Line Business Practice Location Address:
NORTHEAST FLORIDA STATE HOSPITAL
Provider Second Line Business Practice Location Address:
7487 S. STATE ROAD 121
Provider Business Practice Location Address City Name:
MACCLENNY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-259-6211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007