Provider First Line Business Practice Location Address:
444 SOUTH 8TH STREET
Provider Second Line Business Practice Location Address:
SUITE C-1
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-352-1166
Provider Business Practice Location Address Fax Number:
760-339-9944
Provider Enumeration Date:
10/02/2006