Provider First Line Business Practice Location Address:
AVE. PONCE DE LEON 715 PARADA 37
Provider Second Line Business Practice Location Address:
EDIFICIO SAN VICENTE, HOSPITAL AUXILIO MUTUO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2000
Provider Business Practice Location Address Fax Number:
787-771-7434
Provider Enumeration Date:
06/01/2007