Provider First Line Business Mailing Address:
1145 STURGESS STREET, BOX 788250
Provider Second Line Business Mailing Address:
ATTN: FINANCIAL TECHNICIAN
Provider Business Mailing Address City Name:
TWENTYNINE PALMS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92277-8250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-830-2498
Provider Business Mailing Address Fax Number:
760-830-2182