Provider First Line Business Practice Location Address: 
EDIF. SAN JUAN HEALTH CENTRE
    Provider Second Line Business Practice Location Address: 
150 AVE. DE DIEGO
    Provider Business Practice Location Address City Name: 
SAN JUAN PR
    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: 
787-725-8073
    Provider Business Practice Location Address Fax Number: 
787-725-1721
    Provider Enumeration Date: 
07/10/2023