Provider First Line Business Practice Location Address:
3301 COLLEGE AVENUE - MALTZ BLDG
Provider Second Line Business Practice Location Address:
NSU - PSYCHOLOGY SERVICES CENTER
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-262-5831
Provider Business Practice Location Address Fax Number:
954-262-3855
Provider Enumeration Date:
10/24/2006