Provider First Line Business Practice Location Address:
7181 DUMOSA AVE. STE #4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-218-6423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2025