Provider First Line Business Practice Location Address: 
CALLE ISABEL II ESQUINA DEGETAU
    Provider Second Line Business Practice Location Address: 
HOSPITAL BAYAMON HEALTH CENTER AREA SOTANO
    Provider Business Practice Location Address City Name: 
BAYAMON
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00961
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-780-4806
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/09/2014