Provider First Line Business Practice Location Address: 
3610 U.S. HIGHWAY 27 SOUTH
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SEBRING
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33870
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
863-385-5523
    Provider Business Practice Location Address Fax Number: 
863-385-4855
    Provider Enumeration Date: 
09/18/2008