Provider First Line Business Practice Location Address:
1607 ST JAMES CT
Provider Second Line Business Practice Location Address:
TALLAHASSEE OUT PATIENT CLINIC
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-878-0191
Provider Business Practice Location Address Fax Number:
850-878-8900
Provider Enumeration Date:
10/31/2006