Provider First Line Business Practice Location Address:
1550 N. IMPERIAL AVE SUITE 1
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:
760-352-1731
Provider Business Practice Location Address Fax Number:
760-545-0245
Provider Enumeration Date:
01/28/2008