Provider First Line Business Practice Location Address:
258 CALLE SAN JORGE
Provider Second Line Business Practice Location Address:
SAN JORGE MEDICAL BUILDING SUITE 306
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00912-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-268-1274
Provider Business Practice Location Address Fax Number:
787-268-1274
Provider Enumeration Date:
12/03/2005