Provider First Line Business Practice Location Address:
2300 N IMPERIAL AVE STE H
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:
92231-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-890-7050
Provider Business Practice Location Address Fax Number:
877-298-4204
Provider Enumeration Date:
06/14/2021