Provider First Line Business Practice Location Address:
EDIFICIO MEDICAL EMPORIUM II CARR #2 KM 156.5
Provider Second Line Business Practice Location Address:
SUITE A 14
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-265-6644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2010