Provider First Line Business Practice Location Address:
56669 29 PALMS HWY STE E
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:
92284-5229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-625-0137
Provider Business Practice Location Address Fax Number:
888-247-5097
Provider Enumeration Date:
01/23/2015