Provider First Line Business Practice Location Address:
194 SW WALL TERRACE
Provider Second Line Business Practice Location Address:
ORIGINS FAMILY MEDICINE AND WEIGHT LOSS
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-719-9227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2006