Provider First Line Business Practice Location Address:
5707-N 22ND STREET
Provider Second Line Business Practice Location Address:
MENTAL HEALTHCARE, INC. DBA GRACEPOINT
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33610-4350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-239-8069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2016