Provider First Line Business Practice Location Address:
WASHIGNTON #29 ASHFORD MEDICAL CENTER
Provider Second Line Business Practice Location Address:
SUITE 208 -B
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-721-4836
Provider Business Practice Location Address Fax Number:
787-721-8448
Provider Enumeration Date:
01/27/2010