Provider First Line Business Practice Location Address:
1407 CONSTITUTION AVE
Provider Second Line Business Practice Location Address:
1A
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:
619-947-2277
Provider Business Practice Location Address Fax Number:
619-215-0103
Provider Enumeration Date:
08/18/2025