Provider First Line Business Practice Location Address:
77 US HIGHWAY 27 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33852-9571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-699-5437
Provider Business Practice Location Address Fax Number:
863-699-9000
Provider Enumeration Date:
05/24/2018