Provider First Line Business Practice Location Address:
AVE DE DIEGO CALLE CANADA
Provider Second Line Business Practice Location Address:
CENTRO SALUD MENTAL SAN PATRICIO 1324
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-9421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2006