Provider First Line Business Practice Location Address:
58375 29 PALMS HWY STE B
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:
92284-5813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-366-1550
Provider Business Practice Location Address Fax Number:
760-365-9309
Provider Enumeration Date:
10/18/2012