Provider First Line Business Practice Location Address:
MEDICAL EMPORIUM BLDG SUITE 101
Provider Second Line Business Practice Location Address:
AVENIDA HOSTOS #351
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:
787-834-5445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2012