Provider First Line Business Practice Location Address:
7281 DUMOSA AVE STE 2
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:
92284-3781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-2722
Provider Business Practice Location Address Fax Number:
760-365-5099
Provider Enumeration Date:
11/08/2006