Provider First Line Business Practice Location Address:
SUITE A11 CARR #2 KM 156.5
Provider Second Line Business Practice Location Address:
EDIF. MEDICAL EMPORIUM PLAZA II
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682-9999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-652-4338
Provider Business Practice Location Address Fax Number:
787-652-4281
Provider Enumeration Date:
12/08/2014