Provider First Line Business Practice Location Address:
5735 ADOBE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-972-6458
Provider Business Practice Location Address Fax Number:
888-304-1578
Provider Enumeration Date:
04/20/2007