Provider First Line Business Practice Location Address:
BO MACHUELOS CARR 14
Provider Second Line Business Practice Location Address:
PABELLON C 2DO PISO ANEXO HOSP PSIQUIATRIA
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-284-1230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007