Provider First Line Business Practice Location Address:
1200 N CHINA LAKE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-991-6448
Provider Business Practice Location Address Fax Number:
424-369-9555
Provider Enumeration Date:
11/07/2011