Provider First Line Business Practice Location Address:
1073 ROSS AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-353-9994
Provider Business Practice Location Address Fax Number:
760-353-9995
Provider Enumeration Date:
05/17/2007