Provider First Line Business Practice Location Address:
EDIF LA PALMA 14 N PERAL ST
Provider Second Line Business Practice Location Address:
SUITE 4-B
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-1548
Provider Business Practice Location Address Fax Number:
787-834-1919
Provider Enumeration Date:
06/12/2007