Provider First Line Business Practice Location Address:
1111 N CHINA LAKE BLVD STE 501
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:
760-499-3846
Provider Business Practice Location Address Fax Number:
760-499-3832
Provider Enumeration Date:
02/24/2006