Provider First Line Business Practice Location Address:
CALLE CASIA #10
Provider Second Line Business Practice Location Address:
VA CARIBBEAN HEALTH CARE SYSTEM VETERANS HOSPITAL
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-641-7582
Provider Business Practice Location Address Fax Number:
787-641-1621
Provider Enumeration Date:
06/14/2006