Provider First Line Business Practice Location Address:
58383 29 PALMS HWY
Provider Second Line Business Practice Location Address:
SUITE # 100
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-5805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-5864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006