Provider First Line Business Practice Location Address:
401 E BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CALEXICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92231-4351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-768-5246
Provider Business Practice Location Address Fax Number:
760-768-2234
Provider Enumeration Date:
01/22/2007