Provider First Line Business Practice Location Address: 
CENTRO CARDIOVASCULAR DE PR Y EL CARIBE
    Provider Second Line Business Practice Location Address: 
SUITE # 6
    Provider Business Practice Location Address City Name: 
SAN JUAN
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00936
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-751-4298
    Provider Business Practice Location Address Fax Number: 
787-775-0443
    Provider Enumeration Date: 
08/03/2006