Provider First Line Business Practice Location Address:
1 CALLE JOSE CANDELAS
Provider Second Line Business Practice Location Address:
MANATI MEDICAL PLAZA STE. 101
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-5507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-221-0171
Provider Business Practice Location Address Fax Number:
866-542-3629
Provider Enumeration Date:
02/19/2010