Provider First Line Business Practice Location Address:
AVE. HOSTOS 410, MAYAGUEZ MEDICAL CENTER
Provider Second Line Business Practice Location Address:
SUITE 109
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:
787-652-1836
Provider Business Practice Location Address Fax Number:
787-652-1836
Provider Enumeration Date:
06/13/2008