Provider First Line Business Practice Location Address:
CALZADA DEFENSORES #40
Provider Second Line Business Practice Location Address:
CENTRO
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22406
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2025