Provider First Line Business Practice Location Address:
2301 S. HIGHWAY 17
Provider Second Line Business Practice Location Address:
APPLEHOUSE 2
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32112-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-698-1444
Provider Business Practice Location Address Fax Number:
386-698-2537
Provider Enumeration Date:
11/20/2007