Provider First Line Business Practice Location Address:
73 CALLE SANTA CRUZ
Provider Second Line Business Practice Location Address:
EDIF MEDICO STA CRUZ SUITE 315
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-6910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-740-9618
Provider Business Practice Location Address Fax Number:
787-785-7767
Provider Enumeration Date:
08/18/2006