Provider First Line Business Practice Location Address:
119 E. WASHINGTON FLORIDA STATE HOSPITAL,
Provider Second Line Business Practice Location Address:
BUILDING 1214, LANDIS HALL, ROOM 1090
Provider Business Practice Location Address City Name:
CHATTAHOOCHEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32324-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-663-7706
Provider Business Practice Location Address Fax Number:
850-663-7011
Provider Enumeration Date:
11/23/2011