Provider First Line Business Practice Location Address:
6101 LAKE ELLENOR DR.
Provider Second Line Business Practice Location Address:
SOUTHSIDE CLINIC - ORANGE COUNTY HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-858-1424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006