Provider First Line Business Practice Location Address: 
VA CARIBBEAN HEALTHCARE SYSTEM
    Provider Second Line Business Practice Location Address: 
CASIA STREET #10
    Provider Business Practice Location Address City Name: 
SAN JUAN
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00921
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-641-7582
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/23/2008