Provider First Line Business Practice Location Address:
2417 MARSHALL AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-355-0161
Provider Business Practice Location Address Fax Number:
760-355-2596
Provider Enumeration Date:
07/12/2006