Provider First Line Business Practice Location Address:
3200 S UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
NOVA SOUTHEASTERN UNIVERSITY DEPARTMENT OF FAMILY MEDIC
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-262-1449
Provider Business Practice Location Address Fax Number:
954-262-3753
Provider Enumeration Date:
09/06/2006