Provider First Line Business Practice Location Address:
29 WASHINGTON STREET, AVENUE 1451
Provider Second Line Business Practice Location Address:
ASHFORD MEDICAL CENTER, OFFICE 805
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:
787-721-6380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2011