Provider First Line Business Practice Location Address:
CARR 152 KM 2 8
Provider Second Line Business Practice Location Address:
BARRIO QUEBRADILLAS DE BARRANQUITAS
Provider Business Practice Location Address City Name:
BARRANQUITAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-857-7954
Provider Business Practice Location Address Fax Number:
787-857-5249
Provider Enumeration Date:
05/30/2007