Provider First Line Business Practice Location Address:
58471 29 PALMS HWY STE 201
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:
92284-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-1114
Provider Business Practice Location Address Fax Number:
760-228-2066
Provider Enumeration Date:
11/16/2021