Provider First Line Business Practice Location Address:
400 AVE F D ROOSEVELT
Provider Second Line Business Practice Location Address:
CLINICA LAS AMERICAS 104-P
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-920-1050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2012