Provider First Line Business Practice Location Address:
204 POMPANO DRIVE S.E.
Provider Second Line Business Practice Location Address:
18TH MEDICAL GROUP
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-582-1820
Provider Business Practice Location Address Fax Number:
704-919-5000
Provider Enumeration Date:
03/15/2011