Provider First Line Business Practice Location Address:
229 S 8TH ST 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:
92243-2966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-412-5574
Provider Business Practice Location Address Fax Number:
760-412-5575
Provider Enumeration Date:
09/03/2013