Provider First Line Business Practice Location Address:
PARRA MEDICAL PLAZA AVE PONCE BY PASS
Provider Second Line Business Practice Location Address:
SUITE 904-905
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-844-2710
Provider Business Practice Location Address Fax Number:
787-844-2832
Provider Enumeration Date:
05/10/2007