Provider First Line Business Practice Location Address:
JAVIER MINA 1415 2
Provider Second Line Business Practice Location Address:
ZONA URBANA RIO TIJUANA
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22320
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
664-634-0006
Provider Business Practice Location Address Fax Number:
866-272-6924
Provider Enumeration Date:
10/21/2016