Provider First Line Business Practice Location Address:
AVE F.D. ROOSEVELT 101
Provider Second Line Business Practice Location Address:
CUARTEL GENERAL - OFICINA MEDICA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00936-8166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-793-1234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007