Provider First Line Business Practice Location Address:
56872 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:
92284-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-4415
Provider Business Practice Location Address Fax Number:
760-365-0184
Provider Enumeration Date:
11/14/2006