Provider First Line Business Practice Location Address:
SAN GERMAN MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683-0620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-892-4809
Provider Business Practice Location Address Fax Number:
787-892-4809
Provider Enumeration Date:
11/29/2005