Provider First Line Business Practice Location Address:
1011 N CHINA LAKE BLVD
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:
93555-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-499-3640
Provider Business Practice Location Address Fax Number:
760-499-7229
Provider Enumeration Date:
05/24/2006