Provider First Line Business Practice Location Address:
836 PRUDENTIAL DRIVE
Provider Second Line Business Practice Location Address:
UFJAX - DEPARTMENT OF NEUROSURGERY (PEDIATRIC)
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-633-0780
Provider Business Practice Location Address Fax Number:
904-633-0781
Provider Enumeration Date:
08/30/2006