Provider First Line Business Practice Location Address:
1505 ROSS AVE
Provider Second Line Business Practice Location Address:
1505 ROSS AVE
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-353-1720
Provider Business Practice Location Address Fax Number:
760-353-0460
Provider Enumeration Date:
12/05/2006