Provider First Line Business Practice Location Address:
BO PLAYITA
Provider Second Line Business Practice Location Address:
C 71
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-242-7551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2012