Provider First Line Business Practice Location Address:
FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE SCHOOL OF
Provider Second Line Business Practice Location Address:
PA PRACTICE 1115 W CALL STREET
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32306-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-464-1949
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2026