Provider First Line Business Practice Location Address:
AVE VILLA VERDE 1199-2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEXICALI
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
21395
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:
866-272-6924
Provider Enumeration Date:
10/29/2020