Provider First Line Business Practice Location Address:
AVENIDA DE DIEGO CALLE CANADA 1324
Provider Second Line Business Practice Location Address:
CSM SAN PATRICIO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-793-2790
Provider Business Practice Location Address Fax Number:
787-781-2282
Provider Enumeration Date:
06/19/2006