Provider First Line Business Practice Location Address:
57402 TWENTYNINE PALM HIGHWAY
Provider Second Line Business Practice Location Address:
STE 1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2014