Provider First Line Business Practice Location Address:
26734 JORDAN RD.
Provider Second Line Business Practice Location Address:
SUITE A-4
Provider Business Practice Location Address City Name:
HELENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92342-1484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-961-6118
Provider Business Practice Location Address Fax Number:
760-955-2242
Provider Enumeration Date:
05/01/2007