Provider First Line Business Practice Location Address:
AVE. DE DIEGO #150
Provider Second Line Business Practice Location Address:
OFICINA 201 SAN JUAN HEALT CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-230-7557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2009