Provider First Line Business Practice Location Address:
410 S 4TH ST
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:
92243-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-691-1880
Provider Business Practice Location Address Fax Number:
619-427-7607
Provider Enumeration Date:
05/26/2022