Provider First Line Business Practice Location Address:
490 US HIGHWAY 27 N STE 1190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33852-7923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-471-1223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2006