Provider First Line Business Practice Location Address:
931 W INYOKERN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-381-9623
Provider Business Practice Location Address Fax Number:
760-446-3893
Provider Enumeration Date:
04/22/2010