Provider First Line Business Practice Location Address:
URB.PARKHURST LOCAL # 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PUERTO RICO
Provider Business Practice Location Address Postal Code:
00771
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-733-2640
Provider Business Practice Location Address Fax Number:
787-733-2640
Provider Enumeration Date:
09/05/2007