Provider First Line Business Practice Location Address:
MEDICAL EMPORIUM II SUITE 1A
Provider Second Line Business Practice Location Address:
349 HOSTOS AVENUE
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-806-2600
Provider Business Practice Location Address Fax Number:
787-806-2656
Provider Enumeration Date:
07/07/2005