Provider First Line Business Practice Location Address:
909 TITO CASTRO AVE
Provider Second Line Business Practice Location Address:
TORRE MEDICA HOSP SAN LUCAS SUITE 105
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-4802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-651-1435
Provider Business Practice Location Address Fax Number:
787-651-1436
Provider Enumeration Date:
11/20/2006