Provider First Line Business Practice Location Address:
106 STREET KM 2
Provider Second Line Business Practice Location Address:
BO. LA QUINTA CLINICA LA ESPANOLA
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-2094
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2009