Provider First Line Business Practice Location Address:
146 SW ORTHOPAEDIC COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-755-9215
Provider Business Practice Location Address Fax Number:
386-755-6469
Provider Enumeration Date:
09/03/2008