Provider First Line Business Practice Location Address:
2 AVE. HOSTOS
Provider Second Line Business Practice Location Address:
EDIF. MEDICAL EMPORIUM SUITE 406
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:
787-641-0774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2015