Provider First Line Business Practice Location Address:
CARR #2 KM 156.5
Provider Second Line Business Practice Location Address:
MEDICAL EMPORIUM II SUITE A-31
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:
787-241-0430
Provider Business Practice Location Address Fax Number:
939-697-6176
Provider Enumeration Date:
08/25/2010