Provider First Line Business Practice Location Address:
CANADA 16820
Provider Second Line Business Practice Location Address:
APT 3
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22226
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
619-209-8924
Provider Business Practice Location Address Fax Number:
916-625-1368
Provider Enumeration Date:
05/25/2024