Provider First Line Business Practice Location Address:
13000 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
JAMES A. HALEY VA (118M)
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-558-3912
Provider Business Practice Location Address Fax Number:
813-558-3992
Provider Enumeration Date:
09/20/2006