Provider First Line Business Practice Location Address:
4105 PEMBROKE ROAD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF HEALTH
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-985-4818
Provider Business Practice Location Address Fax Number:
954-985-4820
Provider Enumeration Date:
01/21/2009