Provider First Line Business Practice Location Address:
408 E 3RD ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CALEXICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-357-9000
Provider Business Practice Location Address Fax Number:
760-357-9009
Provider Enumeration Date:
02/17/2006