Provider First Line Business Practice Location Address:
63532 29 PALMS HWY
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
JOSHUA TREE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-366-8491
Provider Business Practice Location Address Fax Number:
760-346-2471
Provider Enumeration Date:
02/02/2007