Provider First Line Business Practice Location Address: 
DEPARTMENT OF VETERANS AFFAIRS
    Provider Second Line Business Practice Location Address: 
1601 SW ARCHER ROAD
    Provider Business Practice Location Address City Name: 
GAINESVILLE
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
32608
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
352-376-1611
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/15/2006