Provider First Line Business Practice Location Address:
SAN JUAN HEALTH CENTER SUITE 701
Provider Second Line Business Practice Location Address:
150 AVE DE DIEGO
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:
939-545-8402
Provider Business Practice Location Address Fax Number:
939-545-8439
Provider Enumeration Date:
07/22/2008