Provider First Line Business Practice Location Address:
MONACILLO ST 2116
Provider Second Line Business Practice Location Address:
CENTRO MEDICO DE PUERTO RICO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00922-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2020