Provider First Line Business Practice Location Address:
801 E BIRCH ST STE 4
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:
92231-5925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-768-6000
Provider Business Practice Location Address Fax Number:
760-768-6006
Provider Enumeration Date:
10/17/2024