Provider First Line Business Practice Location Address:
FARMACIA LUIS P R #4 INC
Provider Second Line Business Practice Location Address:
1501 PONCE DE LEON AVE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-1779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-722-1590
Provider Business Practice Location Address Fax Number:
787-724-3722
Provider Enumeration Date:
11/06/2006