Provider First Line Business Practice Location Address:
880 6TH STREET SOUTH
Provider Second Line Business Practice Location Address:
SUITE 170 ALL CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33710-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-767-8989
Provider Business Practice Location Address Fax Number:
727-767-8998
Provider Enumeration Date:
07/27/2009