Provider First Line Business Practice Location Address: 
5000 UNIVERSITY DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CORAL GABLES
    Provider Business Practice Location Address State Name: 
FL
    Provider Business Practice Location Address Postal Code: 
33146-2008
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
786-308-3000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/31/2018