Provider First Line Business Practice Location Address:
182 W. 9TH STREET
Provider Second Line Business Practice Location Address:
VILLA ROSA I, INC.
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33010-4015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-887-8095
Provider Business Practice Location Address Fax Number:
305-887-8014
Provider Enumeration Date:
03/09/2017