Provider First Line Business Practice Location Address:
57725 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:
92284-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-413-3947
Provider Business Practice Location Address Fax Number:
760-327-6327
Provider Enumeration Date:
10/01/2009