Provider First Line Business Practice Location Address:
EDIF MEDICO IV OFIC 106 BO. PUEBLO
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:
00660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-5040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2025