Provider First Line Business Practice Location Address:
58383 29 PALMS HWY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-5891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-820-9229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2008