Provider First Line Business Practice Location Address:
1101 C N PERRY RD
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:
92231-9723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-768-8419
Provider Business Practice Location Address Fax Number:
760-768-8491
Provider Enumeration Date:
10/30/2014