A Doctor of Medicine or equivalent degree from a foreign medical school that provided education and medical knowledge substantially equivalent to accredited schools in the United States may be demonstrated by permanent certification by the Educational Commission for Foreign Medical Graduates (ECFMG) (or a fifth pathway certificate for Americans who completed premedical education in the United States and graduate education in a foreign country). Many facilities and services are offered such as first class golfing venues and renowned universities, a skeet range, riding stables, ice skating rink, state-of-the-art fitness centers, daycare, star-quality dining, full service banking, convenience shop, barbershop, and florist.