Provider First Line Business Practice Location Address:
3001 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
EM DEPT
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-870-4000
Provider Business Practice Location Address Fax Number:
386-274-7801
Provider Enumeration Date:
09/15/2005