Provider First Line Business Practice Location Address:
INTERSECCION CARR. PR-3 Y PR-53, KM. 77
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL PLAZA MALL
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00792-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-1330
Provider Business Practice Location Address Fax Number:
787-852-1733
Provider Enumeration Date:
07/29/2006