Provider First Line Business Practice Location Address:
23 EAST 3RD STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
442-265-1525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2020