Provider First Line Business Practice Location Address:
3001 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
ST JOSEPH'S CHILDREN'S ADVOCACY CENTER
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-615-0589
Provider Business Practice Location Address Fax Number:
813-972-2185
Provider Enumeration Date:
11/09/2006