Provider First Line Business Practice Location Address:
63532 29 PALMS HWY
Provider Second Line Business Practice Location Address:
STE#D
Provider Business Practice Location Address City Name:
JOSHUA TREE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92252-0810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-366-1800
Provider Business Practice Location Address Fax Number:
760-366-2155
Provider Enumeration Date:
03/19/2010