Provider First Line Business Practice Location Address:
2538 CAPITAL MEDICAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-4424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-878-8242
Provider Business Practice Location Address Fax Number:
850-878-7129
Provider Enumeration Date:
08/12/2005