Provider First Line Business Practice Location Address:
1141 DESERTVIEW 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:
92243-9150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-352-4846
Provider Business Practice Location Address Fax Number:
760-352-4846
Provider Enumeration Date:
01/30/2008