Provider First Line Business Practice Location Address:
58471 29 PALMS HWY
Provider Second Line Business Practice Location Address:
SUITE 203
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:
760-365-7651
Provider Business Practice Location Address Fax Number:
760-365-6050
Provider Enumeration Date:
08/19/2006