Provider First Line Business Practice Location Address:
MISION DE SAN DIEGO #2993-304
Provider Second Line Business Practice Location Address:
ZONA RIO
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
B.C.
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-488-2195
Provider Business Practice Location Address Fax Number:
858-430-3143
Provider Enumeration Date:
06/25/2019