Provider First Line Business Practice Location Address:
HUMACAO MEDICAL PLAZA SUITE 201
Provider Second Line Business Practice Location Address:
CALLA FONT MARTELO #53
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-6976
Provider Business Practice Location Address Fax Number:
787-852-6976
Provider Enumeration Date:
08/01/2006