Provider First Line Business Practice Location Address:
72724 29 PALMS HWY STE 107-C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-585-3357
Provider Business Practice Location Address Fax Number:
855-719-3137
Provider Enumeration Date:
10/26/2026