Provider First Line Business Practice Location Address: 
1201 NW 16TH ST DEPT. VETERANS AFFAIRS
    Provider Second Line Business Practice Location Address: 
VA HEALTHCARE SYSTEM
    Provider Business Practice Location Address City Name: 
MIAMI
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33125-1624
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
305-575-5000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/25/2011