Provider First Line Business Practice Location Address: 
HOSPITAL RAMON EMETERIO BETANCES
    Provider Second Line Business Practice Location Address: 
    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: 
787-840-2575
    Provider Business Practice Location Address Fax Number: 
787-840-8391
    Provider Enumeration Date: 
09/25/2006