Provider First Line Business Practice Location Address:
1745 E HALLANDALE BEACH BLVD
Provider Second Line Business Practice Location Address:
1603W
Provider Business Practice Location Address City Name:
HALLANDALE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-236-1839
Provider Business Practice Location Address Fax Number:
516-236-1839
Provider Enumeration Date:
08/02/2005