Provider First Line Business Practice Location Address:
CTIAM ASSMCA PONCE-CARR 14
Provider Second Line Business Practice Location Address:
TERRENOS DEL HOSP SAN LUCAS FINAL
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00732-0073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-6630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2021