Provider First Line Business Practice Location Address:
PRIVADA KUSAMAKI 10802
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BC
Provider Business Practice Location Address Postal Code:
22564
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-488-3200
Provider Business Practice Location Address Fax Number:
619-908-1095
Provider Enumeration Date:
04/22/2022