Provider First Line Business Practice Location Address:
1600 N IMPERIAL AVE
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:
92251-1398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-344-9951
Provider Business Practice Location Address Fax Number:
760-344-6128
Provider Enumeration Date:
04/03/2007