Provider First Line Business Practice Location Address:
225 W RIDGECREST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-307-0719
Provider Business Practice Location Address Fax Number:
818-279-0658
Provider Enumeration Date:
10/20/2025