Provider First Line Business Practice Location Address:
3950 TIGER BAY ROAD
Provider Second Line Business Practice Location Address:
MEDICAL DEPARTMENT TOMOKA CORRECTIONAL INSTITUTION
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32124-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-323-1141
Provider Business Practice Location Address Fax Number:
386-323-1168
Provider Enumeration Date:
05/31/2007