Provider First Line Business Practice Location Address:
852 E DANENBERG DR.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-344-9951
Provider Business Practice Location Address Fax Number:
760-344-5840
Provider Enumeration Date:
11/15/2006