Provider First Line Business Practice Location Address:
1111 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:
93555-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-446-4571
Provider Business Practice Location Address Fax Number:
760-446-8289
Provider Enumeration Date:
09/09/2005