Provider First Line Business Practice Location Address:
CENTRO DETOXIFICACION ASSMCA
Provider Second Line Business Practice Location Address:
AVE.TITO CASTRO CARR.14
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-6935
Provider Business Practice Location Address Fax Number:
787-840-6935
Provider Enumeration Date:
06/06/2007