Provider First Line Business Practice Location Address:
1061 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-274-0790
Provider Business Practice Location Address Fax Number:
386-274-0800
Provider Enumeration Date:
03/23/2007