Provider First Line Business Practice Location Address:
715 AVE PONCE DE LEON
Provider Second Line Business Practice Location Address:
PDA 37 1/2 HOSP AUXILIO MUTUO TORRE MEDICA 502
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-296-0870
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006