Provider First Line Business Practice Location Address:
1550 NORTH IMPERIAL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 2
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:
760-353-5888
Provider Business Practice Location Address Fax Number:
760-545-0246
Provider Enumeration Date:
05/17/2007