Provider First Line Business Practice Location Address: 
CARR 14
    Provider Second Line Business Practice Location Address: 
HOSPITAL MENONITA CAYEY
    Provider Business Practice Location Address City Name: 
CAYEY
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00736-4105
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-535-1001
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/30/2006