Provider First Line Business Practice Location Address: 
VAMC MIAMI
    Provider Second Line Business Practice Location Address: 
1201 N W 16TH ST
    Provider Business Practice Location Address City Name: 
MIAMI
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33125-1693
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
305-575-4455
    Provider Business Practice Location Address Fax Number: 
305-575-3418
    Provider Enumeration Date: 
05/12/2006