Provider First Line Business Practice Location Address:
MAYAGUEZ MEDICAL EMPORIUM II, SUITE A-15
Provider Second Line Business Practice Location Address:
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:
787-831-6429
Provider Business Practice Location Address Fax Number:
787-848-0318
Provider Enumeration Date:
09/21/2010