Provider First Line Business Practice Location Address:
SANTURCE MEDICAL MALL
Provider Second Line Business Practice Location Address:
1801 AVE PONCE DE LEON SUITE 101 B
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-6093
Provider Business Practice Location Address Fax Number:
787-728-6093
Provider Enumeration Date:
01/31/2019