Provider First Line Business Practice Location Address:
721 EMERSON AVE
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:
92231-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-554-5389
Provider Business Practice Location Address Fax Number:
760-357-6597
Provider Enumeration Date:
03/27/2013