Provider First Line Business Practice Location Address:
611 CALLE PAVIA
Provider Second Line Business Practice Location Address:
PAVIA MEDICAL PLAZA SUITE 208
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-268-3200
Provider Business Practice Location Address Fax Number:
787-268-4045
Provider Enumeration Date:
11/30/2005