Provider First Line Business Practice Location Address:
420 E 2ND 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:
92231-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-618-7554
Provider Business Practice Location Address Fax Number:
760-357-1298
Provider Enumeration Date:
11/19/2006