Provider First Line Business Practice Location Address:
2225 PONCE BY PASS
Provider Second Line Business Practice Location Address:
PARRA MEDICAL PLAZA SUITE 408
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-848-8203
Provider Business Practice Location Address Fax Number:
787-848-8204
Provider Enumeration Date:
03/22/2007