Provider First Line Business Practice Location Address:
10070-D JOSE CLEMENTA OROZCO
Provider Second Line Business Practice Location Address:
ZONA RIO
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22000
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
664-687-4332
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2017