Provider First Line Business Practice Location Address:
2030 N IMPERIAL AVE
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:
92243-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-336-3657
Provider Business Practice Location Address Fax Number:
760-336-3648
Provider Enumeration Date:
03/06/2015