Provider First Line Business Practice Location Address:
640 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92363-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-326-4590
Provider Business Practice Location Address Fax Number:
760-326-3154
Provider Enumeration Date:
07/13/2007