Provider First Line Business Practice Location Address:
730 N NORMA 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:
93555-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-375-1200
Provider Business Practice Location Address Fax Number:
760-375-1220
Provider Enumeration Date:
09/27/2013