Provider First Line Business Practice Location Address:
1699 N IMPERIAL AVE STE K
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:
92243-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-542-3313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2023