Provider First Line Business Practice Location Address:
16940 HIGHWAY 14 STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOJAVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93501-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-824-5020
Provider Business Practice Location Address Fax Number:
661-824-5026
Provider Enumeration Date:
06/28/2011