Provider First Line Business Practice Location Address:
1802 W BAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-752-6001
Provider Business Practice Location Address Fax Number:
813-754-3162
Provider Enumeration Date:
09/07/2005