Provider First Line Business Practice Location Address:
72253 29 PALMS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-367-3262
Provider Business Practice Location Address Fax Number:
760-367-0079
Provider Enumeration Date:
06/17/2010