Provider First Line Business Practice Location Address:
351 AVE HOSTOS STE 114
Provider Second Line Business Practice Location Address:
MEDICAL EMPORIEM BLDG
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-986-7273
Provider Business Practice Location Address Fax Number:
787-986-7274
Provider Enumeration Date:
06/03/2010