Provider First Line Business Practice Location Address:
AVE. PONCE DE LEON ESQ. AVE. UNIVERSIDAD
Provider Second Line Business Practice Location Address:
PLAZA UNIVERSITARIA LOCAL #7
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-763-3992
Provider Business Practice Location Address Fax Number:
787-771-6592
Provider Enumeration Date:
09/20/2005