Provider First Line Business Practice Location Address:
CARR #2 AVE. HOSTOS KM 157,
Provider Second Line Business Practice Location Address:
MEDICAL EMPORIUM II SUITE 3A
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:
787-265-6622
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2007