Provider First Line Business Practice Location Address:
1500 N DIXIE HWY
Provider Second Line Business Practice Location Address:
STE 205 PALM BEACH MED-CARE
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-835-8787
Provider Business Practice Location Address Fax Number:
561-835-8487
Provider Enumeration Date:
11/09/2006