Provider First Line Business Practice Location Address:
1441 W STATE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-337-1771
Provider Business Practice Location Address Fax Number:
760-337-1122
Provider Enumeration Date:
07/13/2005