Provider First Line Business Practice Location Address:
PASEO DE DIEGO #158
Provider Second Line Business Practice Location Address:
MARIANO VIDAL ST APS CLINICO OF PR INC
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-641-0774
Provider Business Practice Location Address Fax Number:
787-641-2759
Provider Enumeration Date:
07/28/2006