Provider First Line Business Practice Location Address: 
UNIVERSITY PEDIATRIC HOSPITAL
    Provider Second Line Business Practice Location Address: 
OFFICE 1 A 29
    Provider Business Practice Location Address City Name: 
SAN JUAN
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00936
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-756-4020
    Provider Business Practice Location Address Fax Number: 
787-777-3227
    Provider Enumeration Date: 
06/28/2006