Provider First Line Business Practice Location Address:
CALLE UNION NUM 10 ESTE
Provider Second Line Business Practice Location Address:
FAJARDO MEDICAL PLAZA 102
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-863-4840
Provider Business Practice Location Address Fax Number:
787-863-3205
Provider Enumeration Date:
11/02/2006