Provider First Line Business Practice Location Address: 
SAN JUAN BAUTISTA SCHOOL OF MEDICINE
    Provider Second Line Business Practice Location Address: 
EXPRESO LUIS A. FERR, CAGUAS
    Provider Business Practice Location Address City Name: 
CAGUAS
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00727
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-743-3038
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/26/2021