Provider First Line Business Practice Location Address:
801 N DOWNS ST
Provider Second Line Business Practice Location Address:
STE. I
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-375-0348
Provider Business Practice Location Address Fax Number:
760-375-9818
Provider Enumeration Date:
12/28/2006