Provider First Line Business Practice Location Address:
MEDICAL CENTER PLAZA 740 AVE HOSTOS
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-444-1120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2006