Provider First Line Business Practice Location Address:
290 PALMS MARINE CORPS BASE
Provider Second Line Business Practice Location Address:
23 DENTAL COMPANY
Provider Business Practice Location Address City Name:
29 PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-830-7054
Provider Business Practice Location Address Fax Number:
760-830-7074
Provider Enumeration Date:
09/07/2005