Provider First Line Business Practice Location Address:
205 N. FIRST STREET
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
BLYTHE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-921-3722
Provider Business Practice Location Address Fax Number:
760-922-7200
Provider Enumeration Date:
05/03/2007