Provider First Line Business Practice Location Address:
29 WASHINGTON SUITE 105
Provider Second Line Business Practice Location Address:
ASHFORD MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-725-5628
Provider Business Practice Location Address Fax Number:
787-722-0513
Provider Enumeration Date:
10/03/2006