Provider First Line Business Practice Location Address:
1541 N CHINA LAKE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-446-3800
Provider Business Practice Location Address Fax Number:
760-446-3711
Provider Enumeration Date:
04/29/2011