Provider First Line Business Practice Location Address:
58375 29 PALMS HWY
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:
92284-5813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-9305
Provider Business Practice Location Address Fax Number:
760-365-9309
Provider Enumeration Date:
11/01/2018