Provider First Line Business Practice Location Address:
1CL & 1CP ESTATE DIAMOND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSTED
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-778-3636
Provider Business Practice Location Address Fax Number:
340-719-3636
Provider Enumeration Date:
09/26/2007