Provider First Line Business Practice Location Address:
SAN GERMAN MEDICAL PLAZA ST 2
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683-9340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-892-8700
Provider Business Practice Location Address Fax Number:
787-264-5800
Provider Enumeration Date:
07/17/2009