Provider First Line Business Practice Location Address:
720 N NORMA ST
Provider Second Line Business Practice Location Address:
SUITE A AND B
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-3553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-485-7402
Provider Business Practice Location Address Fax Number:
760-771-4183
Provider Enumeration Date:
10/23/2006