Provider First Line Business Practice Location Address:
ONE ORTHOPAEDIC PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32086-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-825-0540
Provider Business Practice Location Address Fax Number:
904-209-1055
Provider Enumeration Date:
01/23/2006