Provider First Line Business Practice Location Address:
#29 WASHINGTON ST.
Provider Second Line Business Practice Location Address:
ASHFORD MEDICAL CENTER STE 408
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-644-6451
Provider Business Practice Location Address Fax Number:
787-689-5833
Provider Enumeration Date:
03/10/2008