Provider First Line Business Practice Location Address:
FONT MARTELLO STREET #53
Provider Second Line Business Practice Location Address:
HUMACAO MEDICAL PLAZA SUITE 101
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-285-4320
Provider Business Practice Location Address Fax Number:
787-285-4320
Provider Enumeration Date:
08/22/2006