Provider First Line Business Practice Location Address:
351 AVENIDA HOSTOS
Provider Second Line Business Practice Location Address:
SUITE 412 MEDICAL EMPORIUM
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-805-3131
Provider Business Practice Location Address Fax Number:
787-805-3131
Provider Enumeration Date:
03/07/2008