Provider First Line Business Practice Location Address:
1001 E. BIRCH ST, HWY 98
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CALEXICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92231-9759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-890-5593
Provider Business Practice Location Address Fax Number:
760-545-0251
Provider Enumeration Date:
11/10/2006