Provider First Line Business Practice Location Address:
CARR #3 KM 19.9
Provider Second Line Business Practice Location Address:
EAST MEDICAL PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-648-0001
Provider Business Practice Location Address Fax Number:
787-256-5454
Provider Enumeration Date:
10/15/2014