Provider First Line Business Practice Location Address:
1695 NW 9TH AVE
Provider Second Line Business Practice Location Address:
MENTAL HEALTH PHARMACY SUITE # 1311
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-355-7208
Provider Business Practice Location Address Fax Number:
305-355-7196
Provider Enumeration Date:
11/14/2007