Provider First Line Business Practice Location Address:
6568 OASIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-743-3834
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2026