Provider First Line Business Practice Location Address:
7821 DUMOSA AVE STE. 3&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:
92284-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-853-4888
Provider Business Practice Location Address Fax Number:
760-418-2201
Provider Enumeration Date:
09/16/2020