Provider First Line Business Practice Location Address:
CALZ LAZARO MONTEJANO NO 1523
Provider Second Line Business Practice Location Address:
STE 2 INSURGEQNTES OESTE
Provider Business Practice Location Address City Name:
MEXICALI
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
21280
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
686-564-9348
Provider Business Practice Location Address Fax Number:
866-272-6924
Provider Enumeration Date:
10/18/2016