Provider First Line Business Practice Location Address:
2435 MARSHALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92251-9599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-550-6327
Provider Business Practice Location Address Fax Number:
760-550-6331
Provider Enumeration Date:
01/23/2008