Provider First Line Business Practice Location Address:
PR RD 193 KM 1.0
Provider Second Line Business Practice Location Address:
PLAYA AZUL CENTER, LOCAL 5
Provider Business Practice Location Address City Name:
LUQUILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-256-3222
Provider Business Practice Location Address Fax Number:
787-256-3220
Provider Enumeration Date:
03/15/2010