Organization
66101 SUNSET STRIP,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MEDNOLIA MD (VP)
(336) 575-2833
Entity
Organization
Contact information
Practice address
40 SOUTH EAST 5TH STREET, SUITE 406, BOCA RATON, FL 33432
(561) 368-7118
(561) 368-7116
Mailing address
40 SE 5TH ST STE 406, BOCA RATON, FL 33432-6003
(561) 368-7118
(561) 368-7116
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
22512
NJ
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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