Provider First Line Business Practice Location Address:
351 E BIRCH ST
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:
92231-4350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-357-2400
Provider Business Practice Location Address Fax Number:
760-357-3337
Provider Enumeration Date:
08/31/2006