Provider First Line Business Practice Location Address:
# 53 FONT MARTELO AVE. ESTE
Provider Second Line Business Practice Location Address:
SUITE 202 HUMACAO MEDICAL PLAZA
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-285-6767
Provider Business Practice Location Address Fax Number:
787-285-0494
Provider Enumeration Date:
01/02/2007