Provider First Line Business Practice Location Address:
1215 KINGSLEY AVE.
Provider Second Line Business Practice Location Address:
CONSULATE HEALTHCARE OF ORANGE PARK
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-541-3293
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2013