Provider First Line Business Practice Location Address:
55 DR BASORA ST N, EDIF MEDICO IV
Provider Second Line Business Practice Location Address:
OFFICE 206
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:
787-652-3774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2010