Provider First Line Business Practice Location Address:
8129 CALLE CONCORDIA
Provider Second Line Business Practice Location Address:
CONCORDIA MEDICAL BUILDING, SUITE 2-C
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-640-0099
Provider Business Practice Location Address Fax Number:
787-844-9572
Provider Enumeration Date:
11/14/2007