Provider First Line Business Practice Location Address:
10 CALLE UN E
Provider Second Line Business Practice Location Address:
FAJARDO MEDICAL PLAZA SUITE 204
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-4817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-863-3450
Provider Business Practice Location Address Fax Number:
787-860-5203
Provider Enumeration Date:
11/14/2005