Provider First Line Business Practice Location Address:
495 E BIRCH ST STE A
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:
92231-2374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-482-5000
Provider Business Practice Location Address Fax Number:
760-337-9199
Provider Enumeration Date:
04/05/2022