Provider First Line Business Practice Location Address:
735 AVE PONCE DE LEON, TORRE MEDICA AUXILIO MUTUO 602
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-645-8154
Provider Business Practice Location Address Fax Number:
939-437-4397
Provider Enumeration Date:
12/28/2006