Provider First Line Business Practice Location Address:
STATE ROAD 108 BLDG 3005
Provider Second Line Business Practice Location Address:
DEWERT BRANCH HEALTH CLINIC
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93517-7777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-932-1616
Provider Business Practice Location Address Fax Number:
760-932-1623
Provider Enumeration Date:
08/19/2007