Kindly complete your registration by providing the details below.

Personal & Professional:

Personal & Professional Information

Last Name:
Karina
First Name:
Arieta
Hospital / Institution / Company:
Hospital Espa¤ol
Address:

Affiliation

Street and House Number:
Av. Gral. Garibaldi 1729
City:
Montevideo
Zip Code:
11800
State:
0
Country:
Uruguay
Membership benefits:

Membership benefits

Site Information:

Site Information

program set up:
0
currently taken care:
0
approximate number:
0
normally referred:
0