Provider First Line Business Practice Location Address:
SANTURCE MEDICAL MALL
Provider Second Line Business Practice Location Address:
PONCE DE LEON PARADA 26
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-728-7228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2006