Provider First Line Business Practice Location Address:
118 CARR 159 STE 2B
Provider Second Line Business Practice Location Address:
ORTIZ MEDICAL PLAZA
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-859-4973
Provider Business Practice Location Address Fax Number:
787-859-5152
Provider Enumeration Date:
10/01/2014