Provider First Line Business Practice Location Address: 
CARR 693 ESQUINA AVE JOSE EFRAIN
    Provider Second Line Business Practice Location Address: 
DOCTORS CENTER CLINIC DORADO PLAZA DORADA SHOPPING #24
    Provider Business Practice Location Address City Name: 
DORADO
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00646-0000
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-360-0680
    Provider Business Practice Location Address Fax Number: 
939-697-6110
    Provider Enumeration Date: 
09/03/2009