Provider First Line Business Practice Location Address:
57675 29 PALMS HWY
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-3098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-8500
Provider Business Practice Location Address Fax Number:
760-365-8599
Provider Enumeration Date:
08/19/2006