Provider First Line Business Practice Location Address:
58295 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:
92284-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-6300
Provider Business Practice Location Address Fax Number:
760-396-1200
Provider Enumeration Date:
07/26/2006