Provider First Line Business Practice Location Address: 
7000 SW 62ND AVE
    Provider Second Line Business Practice Location Address: 
300
    Provider Business Practice Location Address City Name: 
SOUTH MIAMI
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33143-4716
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
305-455-7454
    Provider Business Practice Location Address Fax Number: 
305-455-7441
    Provider Enumeration Date: 
07/13/2016