Provider First Line Business Practice Location Address:
32784 OLDWOMAN SPRINGS RD.
Provider Second Line Business Practice Location Address:
D
Provider Business Practice Location Address City Name:
LUCERNE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-248-6828
Provider Business Practice Location Address Fax Number:
760-248-6700
Provider Enumeration Date:
05/29/2007