Provider First Line Business Practice Location Address: 
600 N UNIVERSITY DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PEMBROKE PINES
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33024-6731
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
954-433-4400
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/19/2013