Provider First Line Business Practice Location Address:
AVE VENECIA N-2 22791
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BC
Provider Business Practice Location Address Postal Code:
22205
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
562-352-0417
Provider Business Practice Location Address Fax Number:
562-366-0560
Provider Enumeration Date:
08/26/2024