Provider First Line Business Practice Location Address:
MANATI MEDICAL PLAZA SUITE 208
Provider Second Line Business Practice Location Address:
JOSE CANDELAS #1
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-884-6991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007