Provider First Line Business Practice Location Address:
CALLE SAN JORGE #252 SAN JORGE MEDIICAL OFFICE
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-726-0210
Provider Business Practice Location Address Fax Number:
787-728-5136
Provider Enumeration Date:
08/20/2006