Provider First Line Business Practice Location Address:
420 NE 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-524-2336
Provider Business Practice Location Address Fax Number:
954-524-2219
Provider Enumeration Date:
04/11/2006