Provider First Line Business Practice Location Address: 
HOSPITAL UPR
    Provider Second Line Business Practice Location Address: 
AVE. 65 INFANTERIA K 8.3
    Provider Business Practice Location Address City Name: 
CAROLINA
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00984
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-757-1800
    Provider Business Practice Location Address Fax Number: 
787-769-4520
    Provider Enumeration Date: 
08/07/2006