Provider First Line Business Practice Location Address:
223 S WATERMAN AVE STE A
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:
92243-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-444-9002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2026