Provider First Line Business Practice Location Address:
12 CALLE VICTORIA BARRIO TEJAS SUITE 6
Provider Second Line Business Practice Location Address:
LEGACY MEDICAL CENTER
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-402-0262
Provider Business Practice Location Address Fax Number:
787-852-5869
Provider Enumeration Date:
06/05/2019