Provider First Line Business Practice Location Address:
1020 E BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92363-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-326-2944
Provider Business Practice Location Address Fax Number:
760-326-6290
Provider Enumeration Date:
06/05/2011