Provider First Line Business Practice Location Address:
611 MANUEL PAVIA FERNANDEZ ST.
Provider Second Line Business Practice Location Address:
PAVIA MEDICAL PLAZA, SUITE 206
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-6212
Provider Business Practice Location Address Fax Number:
787-728-8587
Provider Enumeration Date:
01/17/2007