Provider First Line Business Practice Location Address:
1830 NW 183RD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPA LOCKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-621-1400
Provider Business Practice Location Address Fax Number:
305-620-4680
Provider Enumeration Date:
10/27/2006