Provider First Line Business Practice Location Address:
PLAZA PALMA REAL
Provider Second Line Business Practice Location Address:
STATE RD. #3 KM 77.6 RIO ABAJO
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:
787-852-9680
Provider Business Practice Location Address Fax Number:
787-852-9671
Provider Enumeration Date:
03/01/2007