Provider First Line Business Practice Location Address:
4700 W PROSPECT RD
Provider Second Line Business Practice Location Address:
SUITE 107 GALAXY MEDICAL
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-8001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-731-8977
Provider Business Practice Location Address Fax Number:
954-731-8722
Provider Enumeration Date:
08/09/2005