Provider First Line Business Practice Location Address:
252 CALLE SAN JORGE STE 307
Provider Second Line Business Practice Location Address:
SAN JORGE MEDICAL BUILDING
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00912-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-7775
Provider Business Practice Location Address Fax Number:
787-728-7755
Provider Enumeration Date:
12/18/2006