Provider First Line Business Practice Location Address:
AV. FRANCISCO I. MADERO 1268-A
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:
21100
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
760-592-6132
Provider Business Practice Location Address Fax Number:
858-430-3143
Provider Enumeration Date:
07/30/2019