Provider First Line Business Practice Location Address:
1611 NW 12TH AVE STE 109
Provider Second Line Business Practice Location Address:
JACKSON MEMORIAL HOSPITAL HOLTZ CHILDRENS HOSPITAL
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-585-6683
Provider Business Practice Location Address Fax Number:
305-324-6012
Provider Enumeration Date:
06/27/2006