Provider First Line Business Practice Location Address:
BAYAMON MEDICAL MALL # 1845
Provider Second Line Business Practice Location Address:
CARR #2 ST 209
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-620-2098
Provider Business Practice Location Address Fax Number:
787-779-8178
Provider Enumeration Date:
02/24/2006