Provider First Line Business Practice Location Address: 
LOTE 18 METRO OFFICE PARK
    Provider Second Line Business Practice Location Address: 
3RD FLOOR SUITE 3000 AMERICAN HEALTH MEDICARE BUILDING
    Provider Business Practice Location Address City Name: 
GUAYNABO
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00968
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-620-1919
    Provider Business Practice Location Address Fax Number: 
787-620-0570
    Provider Enumeration Date: 
12/28/2012