Provider First Line Business Practice Location Address:
408 E 3RD ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALEXICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92231-2854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-357-9962
Provider Business Practice Location Address Fax Number:
760-768-1714
Provider Enumeration Date:
10/20/2006