Provider First Line Business Practice Location Address:
435 W ATEN RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92251-9819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-284-1442
Provider Business Practice Location Address Fax Number:
760-203-3930
Provider Enumeration Date:
01/16/2007