Provider First Line Business Practice Location Address:
1210 US HIGHWAY 27 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33852-7948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-402-3402
Provider Business Practice Location Address Fax Number:
863-402-3111
Provider Enumeration Date:
03/20/2018