Provider First Line Business Practice Location Address:
HUMACAO MEDICAL PLAZA SUITE 204 FONT MARTELO AVE. 53 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00792-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-7733
Provider Business Practice Location Address Fax Number:
787-852-7733
Provider Enumeration Date:
04/19/2006