Provider First Line Business Practice Location Address:
2946 LAKELAND HIGHLANDS RD
Provider Second Line Business Practice Location Address:
HIGHLANDS PLAZA
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33803-4379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-583-1674
Provider Business Practice Location Address Fax Number:
863-583-1678
Provider Enumeration Date:
10/31/2005