Provider First Line Business Practice Location Address:
133 E CALIFORNIA AVE
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:
93555-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-375-3988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2006