Provider First Line Business Practice Location Address:
2736 UNIVERSITY BLVD W STE 3
Provider Second Line Business Practice Location Address:
CREDENTIALING DEPARTMENT
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32217-2170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-733-4262
Provider Business Practice Location Address Fax Number:
904-636-5786
Provider Enumeration Date:
06/20/2005