Provider First Line Business Practice Location Address:
AVE HOSTOS 351
Provider Second Line Business Practice Location Address:
MEDICAL EMPORIUM BUILDING SUITE 312
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:
787-831-6595
Provider Business Practice Location Address Fax Number:
787-831-6575
Provider Enumeration Date:
01/12/2006