Provider First Line Business Practice Location Address:
56165 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:
92284-2880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-0351
Provider Business Practice Location Address Fax Number:
760-365-9689
Provider Enumeration Date:
05/14/2007