Provider First Line Business Practice Location Address:
STREET NUM 2 KM 48.3
Provider Second Line Business Practice Location Address:
STREET JOSE CANDELAS OFFICE NUM 203 MANATI MEDICAL MALL
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-884-4629
Provider Business Practice Location Address Fax Number:
787-292-5050
Provider Enumeration Date:
10/31/2019