Provider First Line Business Practice Location Address:
BUREAU OF MEDICINE AND SURGERY, CENTRALIZED CREDENTIALS
Provider Second Line Business Practice Location Address:
& PRIVILEGING DIRECTORATE - 554 KEILY STREET
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-953-8609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2013