Provider First Line Business Practice Location Address:
8175 NW 12TH STREET
Provider Second Line Business Practice Location Address:
SUITE 306 (ATT: J. BASSI)
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-845-0164
Provider Business Practice Location Address Fax Number:
786-845-0176
Provider Enumeration Date:
10/10/2006