Provider First Line Business Practice Location Address:
4648 GRAND BOULEVARD
Provider Second Line Business Practice Location Address:
FLORIDA MEDICAL CENTER DOUGLAS WERT MD
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-842-7397
Provider Business Practice Location Address Fax Number:
727-842-7790
Provider Enumeration Date:
05/12/2006