Provider First Line Business Practice Location Address:
5686 US HIGHWAY 129 SOUTH
Provider Second Line Business Practice Location Address:
SCHOOL CLINIC
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-792-8000
Provider Business Practice Location Address Fax Number:
386-755-4432
Provider Enumeration Date:
07/17/2018