Provider First Line Business Practice Location Address:
1601 N IMPERIAL AVE STE B
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:
92243-1399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-592-4650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2020