Provider First Line Business Practice Location Address:
120 W COLE BLVD. SUITE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-455-2194
Provider Business Practice Location Address Fax Number:
760-890-0160
Provider Enumeration Date:
09/14/2012