Provider First Line Business Practice Location Address:
AVE BARBOSA 608
Provider Second Line Business Practice Location Address:
CLINICA DENTAL COMUNITARIA CANTERA SUITE 4
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00919-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-4190
Provider Business Practice Location Address Fax Number:
787-728-4190
Provider Enumeration Date:
03/23/2007