Provider First Line Business Practice Location Address:
PLAYA AZUL CENTER LOCAL 4 C/193 KM 1.0
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUQUILLO
Provider Business Practice Location Address State Name:
PUERTO RICO
Provider Business Practice Location Address Postal Code:
00738
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-889-3191
Provider Business Practice Location Address Fax Number:
787-889-4313
Provider Enumeration Date:
10/24/2008