Provider First Line Business Practice Location Address:
1324 LAKELAND HILLS BLVD
Provider Second Line Business Practice Location Address:
MANAGED CARE DEPT
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-687-1321
Provider Business Practice Location Address Fax Number:
863-603-6534
Provider Enumeration Date:
10/10/2005