Provider First Line Business Practice Location Address:
29 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE #702 ASHFORD MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-721-4404
Provider Business Practice Location Address Fax Number:
787-721-4699
Provider Enumeration Date:
04/19/2007