Provider First Line Business Practice Location Address:
349 HOSTOS AVE, MEDICAL EMPORIUM II
Provider Second Line Business Practice Location Address:
SUITE A33
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:
787-265-4477
Provider Business Practice Location Address Fax Number:
888-872-7301
Provider Enumeration Date:
10/28/2009