Provider First Line Business Practice Location Address:
8415 BAYSHORE BLVD.
Provider Second Line Business Practice Location Address:
LIFE SKILLS SUPPORT CENTER (6 MDOS/GOH)
Provider Business Practice Location Address City Name:
MACDILL AFB
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-827-9170
Provider Business Practice Location Address Fax Number:
819-828-6868
Provider Enumeration Date:
09/15/2006