Provider First Line Business Practice Location Address:
AVE VILLAS OBREGON 338
Provider Second Line Business Practice Location Address:
LOCAL 3 VILLAS DE LA REPUBLICA
Provider Business Practice Location Address City Name:
MEXICALI
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
21390
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
686-133-1330
Provider Business Practice Location Address Fax Number:
866-272-6924
Provider Enumeration Date:
10/18/2016