Provider First Line Business Practice Location Address:
55818 29 PALMS HWY
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:
92284-2596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-660-9115
Provider Business Practice Location Address Fax Number:
760-418-5618
Provider Enumeration Date:
01/12/2016