Provider First Line Business Practice Location Address:
DR. BASORA 55N
Provider Second Line Business Practice Location Address:
MEDICO IV OFIC. 106
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:
787-832-9783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007