Provider First Line Business Practice Location Address:
CALLE DR BASORA 55 N
Provider Second Line Business Practice Location Address:
EDIF MEDICO IV OFICINA 201
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:
787-265-5583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007