Provider First Line Business Practice Location Address:
5614 SAN JOSE BLVD
Provider Second Line Business Practice Location Address:
UFJP SAN JOSE FAMILY PRACTICE CENTER
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-7616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-733-2370
Provider Business Practice Location Address Fax Number:
904-730-2924
Provider Enumeration Date:
03/09/2006