Provider First Line Business Practice Location Address:
3100 SW 62ND AVE
Provider Second Line Business Practice Location Address:
NICKLAUS CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-624-2891
Provider Business Practice Location Address Fax Number:
305-669-6531
Provider Enumeration Date:
10/24/2007