Provider First Line Business Practice Location Address: 
CALLE JOSE C. VAZQUEZ
    Provider Second Line Business Practice Location Address: 
HOSPITAL MENONITA AIBONITO
    Provider Business Practice Location Address City Name: 
AIBONITO
    Provider Business Practice Location Address State Name: 
PR
    Provider Business Practice Location Address Postal Code: 
00705
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
787-205-9018
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/02/2005