Provider First Line Business Practice Location Address: 
6000 N FEDERAL HWY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
FORT LAUDERDALE
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33308-2226
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
954-202-6200
    Provider Business Practice Location Address Fax Number: 
954-202-6207
    Provider Enumeration Date: 
10/06/2006