Provider First Line Business Practice Location Address:
CALLE BASORA 55H
Provider Second Line Business Practice Location Address:
EDIT MEDICO III OFIC 201
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:
787-265-5583
Provider Business Practice Location Address Fax Number:
787-265-8145
Provider Enumeration Date:
11/22/2006