Provider First Line Business Practice Location Address:
LUMAR PLAZA, 1847 PSL BLVD
Provider Second Line Business Practice Location Address:
WELLMED MEDICAL MANAGMENT OF FLORIDA, INC.
Provider Business Practice Location Address City Name:
PORT ST. LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
94952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-579-2303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2006