Provider First Line Business Practice Location Address:
55-N DR BASORA ST,
Provider Second Line Business Practice Location Address:
EDIF. MEDICO IV, OFIC. 1-C
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:
787-833-9060
Provider Business Practice Location Address Fax Number:
787-833-9060
Provider Enumeration Date:
10/19/2006