Provider First Line Business Practice Location Address:
1001 E BIRCH ST STE 1
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:
92231-5915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-890-5593
Provider Business Practice Location Address Fax Number:
760-545-0251
Provider Enumeration Date:
03/15/2023