Provider First Line Business Practice Location Address:
DR BASORA STREET 55N
Provider Second Line Business Practice Location Address:
EDIFICIO MEDICO IV
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-831-6422
Provider Business Practice Location Address Fax Number:
787-831-6428
Provider Enumeration Date:
06/29/2007