Provider First Line Business Practice Location Address:
MEDICAL EMPORIUM 351 AVENIDA HOSTOS
Provider Second Line Business Practice Location Address:
SUITE 202
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:
787-805-5610
Provider Business Practice Location Address Fax Number:
787-805-5670
Provider Enumeration Date:
01/04/2012