Provider First Line Business Practice Location Address: 
UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SAN JUAN
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00926-5067
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-403-0724
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/31/2024