Provider First Line Business Practice Location Address:
27274 PEACH TREE LANE
Provider Second Line Business Practice Location Address:
P.O. BOX 249
Provider Business Practice Location Address City Name:
HELENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-952-1204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2026