Provider First Line Business Practice Location Address:
ASSMCA 410 AVE HOSTOS
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-2325
Provider Business Practice Location Address Fax Number:
787-832-2325
Provider Enumeration Date:
05/09/2007