Provider First Line Business Practice Location Address:
58471 TWENTY-NINE PALMS HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-853-4755
Provider Business Practice Location Address Fax Number:
760-418-2201
Provider Enumeration Date:
05/04/2026