Provider First Line Business Practice Location Address:
1051 CALLE 3 SE
Provider Second Line Business Practice Location Address:
MEDICAL CENTER PLAZA 610, LA RIVIERA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-775-2412
Provider Business Practice Location Address Fax Number:
787-781-1110
Provider Enumeration Date:
04/13/2006