Provider First Line Business Practice Location Address:
3501 JOHNSON STREET 2ND FLOOR SUITE 200
Provider Second Line Business Practice Location Address:
JOE DIMAGGIO CHILDREN'S HOSPITAL MEDICAL OFFICE CENTRE
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-262-2187
Provider Business Practice Location Address Fax Number:
954-262-2910
Provider Enumeration Date:
12/17/2008