Provider First Line Business Practice Location Address:
58424 CANTERBURY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-8648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-965-9330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2026