Provider First Line Business Practice Location Address:
750 N IMPERIAL AVE
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:
92243-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-353-2720
Provider Business Practice Location Address Fax Number:
760-353-3591
Provider Enumeration Date:
02/13/2007