Provider First Line Business Practice Location Address:
495 E ORANGE 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:
92243-2744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-353-3331
Provider Business Practice Location Address Fax Number:
760-353-5085
Provider Enumeration Date:
12/26/2007