Provider First Line Business Practice Location Address:
57463 29 PALMS HWY
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:
92284-2925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-1856
Provider Business Practice Location Address Fax Number:
760-228-1897
Provider Enumeration Date:
12/29/2006