Provider First Line Business Practice Location Address:
1590 S IMPERIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-970-8906
Provider Business Practice Location Address Fax Number:
760-970-4070
Provider Enumeration Date:
07/02/2009