Provider First Line Business Practice Location Address:
351 AVE HOSTOS
Provider Second Line Business Practice Location Address:
MEDICAL EMPORIUM SUITE 208
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-805-7640
Provider Business Practice Location Address Fax Number:
787-805-7620
Provider Enumeration Date:
05/24/2006