Provider First Line Business Practice Location Address:
56669 TWENTYNINE PALMS HWY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-905-9560
Provider Business Practice Location Address Fax Number:
888-247-5097
Provider Enumeration Date:
04/23/2026