Provider First Line Business Practice Location Address:
CARR 159 KM 13.4
Provider Second Line Business Practice Location Address:
ORTIZ MEDICAL PLAZA
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-859-5968
Provider Business Practice Location Address Fax Number:
787-859-5968
Provider Enumeration Date:
12/12/2006