Provider First Line Business Practice Location Address:
CARR 174 KM 0.4 SUITE 105A
Provider Second Line Business Practice Location Address:
OLAZABAL MALL MENTAL HEALTH SOLUTIONS OF PR LLC
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-607-5109
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2009