Provider First Line Business Practice Location Address:
100826 NIPTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-856-1056
Provider Business Practice Location Address Fax Number:
760-856-1050
Provider Enumeration Date:
12/06/2012