Provider First Line Business Practice Location Address:
56351 29 PALMS HWY STE C
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:
92284-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-8729
Provider Business Practice Location Address Fax Number:
760-365-8732
Provider Enumeration Date:
01/02/2007