Provider First Line Business Practice Location Address:
1655 E JACKSON ST,
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:
619-272-9021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2023