Provider First Line Business Practice Location Address:
EDIF CLINICA LAS AMERICAS OFIC 205
Provider Second Line Business Practice Location Address:
400 ROOSEVELT AVE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-765-1919
Provider Business Practice Location Address Fax Number:
787-763-4049
Provider Enumeration Date:
10/25/2005