Provider First Line Business Practice Location Address:
1535 N CHINA LAKE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-446-9007
Provider Business Practice Location Address Fax Number:
760-446-6900
Provider Enumeration Date:
06/29/2012