Provider First Line Business Practice Location Address:
CALLE 35E1051
Provider Second Line Business Practice Location Address:
APT 401 COND MEDICAL CENTER PLAZA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-370-2994
Provider Business Practice Location Address Fax Number:
787-793-7892
Provider Enumeration Date:
04/06/2007