Provider First Line Business Practice Location Address:
1111 N CHINA LAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-499-3855
Provider Business Practice Location Address Fax Number:
760-499-3870
Provider Enumeration Date:
05/27/2006