Provider First Line Business Practice Location Address:
949 PALM AVENUE
Provider Second Line Business Practice Location Address:
IMPERIAL BEACH HEALTH CENTER
Provider Business Practice Location Address City Name:
IMPERIAL BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-429-3733
Provider Business Practice Location Address Fax Number:
619-628-5550
Provider Enumeration Date:
10/02/2006