Provider First Line Business Practice Location Address:
6335 PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOSHUA TREE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92252-2370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-366-8474
Provider Business Practice Location Address Fax Number:
760-366-8560
Provider Enumeration Date:
03/01/2006