Provider First Line Business Practice Location Address:
2433 MARSHALL AVE STE 1
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:
92251-9599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-545-0022
Provider Business Practice Location Address Fax Number:
760-545-0050
Provider Enumeration Date:
05/14/2008