Provider First Line Business Practice Location Address:
FD ROOSEVELT AVENUE
Provider Second Line Business Practice Location Address:
#1441
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-793-8383
Provider Business Practice Location Address Fax Number:
787-774-4839
Provider Enumeration Date:
08/28/2006