Provider First Line Business Practice Location Address:
65TH INFANTRY SH. CTR 00253-5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00925-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-1736
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2026