Provider First Line Business Practice Location Address:
57463 TWENTY NINE PALMS HWY SUITE 203
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-228-1855
Provider Business Practice Location Address Fax Number:
760-228-1897
Provider Enumeration Date:
10/04/2006