Provider First Line Business Practice Location Address:
829 N DOWNS ST
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:
93555-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-371-7600
Provider Business Practice Location Address Fax Number:
760-371-2200
Provider Enumeration Date:
01/06/2009