Provider First Line Business Practice Location Address:
1041 N CHINA LAKE BLVD STE A
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:
93555-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-446-2984
Provider Business Practice Location Address Fax Number:
760-446-2987
Provider Enumeration Date:
02/27/2008