Provider First Line Business Practice Location Address:
JOSE CLEMENTE OROZCO 10122
Provider Second Line Business Practice Location Address:
PH 4
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
TIJUANA, BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-565-1300
Provider Business Practice Location Address Fax Number:
866-272-6924
Provider Enumeration Date:
01/23/2017