Provider First Line Business Practice Location Address:
1 ADMINISTRATION CIRCLE, STOP 1311
Provider Second Line Business Practice Location Address:
BRANCH CLINIC CHINA LAKE, BLDG 1403
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:
760-939-8025
Provider Business Practice Location Address Fax Number:
760-939-0400
Provider Enumeration Date:
07/02/2012