Provider First Line Business Practice Location Address:
WALGREENS - STORE #4399
Provider Second Line Business Practice Location Address:
2425 US HIGHWAY 92 EAST
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33801-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-666-6670
Provider Business Practice Location Address Fax Number:
863-666-6675
Provider Enumeration Date:
11/17/2010