Provider First Line Business Practice Location Address:
1081 N CHINA LAKE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-446-3551
Provider Business Practice Location Address Fax Number:
760-499-3014
Provider Enumeration Date:
03/14/2006