Provider First Line Business Practice Location Address:
1845 CARR #2 BAYAMON MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 808
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PUERTO RICO
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-785-4410
Provider Business Practice Location Address Fax Number:
787-785-4412
Provider Enumeration Date:
04/03/2012