Provider First Line Business Practice Location Address:
1402 BAILEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92363-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-326-0222
Provider Business Practice Location Address Fax Number:
760-326-0221
Provider Enumeration Date:
04/01/2014