Provider First Line Business Practice Location Address:
ROSADA MEDICAL BUILDING
Provider Second Line Business Practice Location Address:
AVE FONT MARTCLO #358
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-285-8093
Provider Business Practice Location Address Fax Number:
787-285-5209
Provider Enumeration Date:
01/24/2006