Provider First Line Business Practice Location Address:
AV JOSE CANDELA #1
Provider Second Line Business Practice Location Address:
SUITE 201 MANATI MEDICAL PLAZA
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:
787-884-6800
Provider Business Practice Location Address Fax Number:
787-884-6800
Provider Enumeration Date:
12/05/2006