Provider First Line Business Practice Location Address:
CALLE 3 NUM 80 SUR
Provider Second Line Business Practice Location Address:
SOUTHERN MEDICAL PLAZA
Provider Business Practice Location Address City Name:
GUAYAMA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-866-1212
Provider Business Practice Location Address Fax Number:
787-866-3322
Provider Enumeration Date:
12/09/2005