Provider First Line Business Practice Location Address:
1695 NW 9TH AVENUE, RM 2506
Provider Second Line Business Practice Location Address:
JACKSON MEMORIAL HOSPITAL, MENTAL HEALTH HOSPITAL CENTE
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-723-8361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2006