Provider First Line Business Practice Location Address:
BAYAMON MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
CARR#2 OFIC 104A
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:
787-798-9522
Provider Business Practice Location Address Fax Number:
787-798-9500
Provider Enumeration Date:
05/08/2013