Provider First Line Business Practice Location Address:
BAYAMON MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 711 CARR 2 KM 11-7
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-787-8210
Provider Business Practice Location Address Fax Number:
787-785-8589
Provider Enumeration Date:
05/03/2006