Provider First Line Business Practice Location Address:
AVENIDA VIENA 1616-C
Provider Second Line Business Practice Location Address:
COL. ROMA
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22054
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
664-135-2004
Provider Business Practice Location Address Fax Number:
619-354-2449
Provider Enumeration Date:
03/29/2023