Provider First Line Business Practice Location Address:
OFIC. 563 EDIF. PRINCIPAL RCM
Provider Second Line Business Practice Location Address:
CENTRO MEDICO DE PUERTO RICO
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00935-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-754-9165
Provider Business Practice Location Address Fax Number:
787-274-8156
Provider Enumeration Date:
07/19/2011