Provider First Line Business Practice Location Address:
1 ADMINISTRATION CIR STOP 1311
Provider Second Line Business Practice Location Address:
BHC CHINA LAKE
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-939-1657
Provider Business Practice Location Address Fax Number:
760-939-6582
Provider Enumeration Date:
11/08/2007