Provider First Line Business Practice Location Address:
1600 S IMPERIAL AVE
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-336-0333
Provider Business Practice Location Address Fax Number:
760-336-2333
Provider Enumeration Date:
03/19/2008