Provider First Line Business Practice Location Address:
2026 N. IMPERIAL AVE.
Provider Second Line Business Practice Location Address:
SUITE D
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-693-5372
Provider Business Practice Location Address Fax Number:
760-693-5375
Provider Enumeration Date:
09/30/2016