Provider First Line Business Practice Location Address:
MCCS, BHB, SACC
Provider Second Line Business Practice Location Address:
BLDG 1437 DOOR 6
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-830-6986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2021