Provider First Line Business Practice Location Address:
AVE JOSE C BARBOSA
Provider Second Line Business Practice Location Address:
# 225
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-733-3508
Provider Business Practice Location Address Fax Number:
787-733-0925
Provider Enumeration Date:
02/28/2006