Provider First Line Business Practice Location Address:
2302 BROWN ROAD
Provider Second Line Business Practice Location Address:
DENTAL DEPT
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92251-0731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-733-7900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2007