Provider First Line Business Practice Location Address:
CARR 385 ICM 0-5
Provider Second Line Business Practice Location Address:
PENUELOS MEDICAL BUILDING
Provider Business Practice Location Address City Name:
PENUELOS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-836-2999
Provider Business Practice Location Address Fax Number:
787-836-2999
Provider Enumeration Date:
10/10/2005