Provider First Line Business Practice Location Address:
380 N 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 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:
92243-2336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-352-6302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2006