Provider First Line Business Practice Location Address:
29 CALLE WASHINGTON
Provider Second Line Business Practice Location Address:
SUITE 104 ASHFORD MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-429-9129
Provider Business Practice Location Address Fax Number:
787-998-3335
Provider Enumeration Date:
02/22/2007