Provider First Line Business Practice Location Address:
29 CALLE WASHINGTON
Provider Second Line Business Practice Location Address:
ASHFORD MEDICAL CENTER STE 505
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-596-7878
Provider Business Practice Location Address Fax Number:
787-721-2204
Provider Enumeration Date:
06/14/2007