Provider First Line Business Practice Location Address:
8155 BALSA AVE
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:
92284-6155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-368-1000
Provider Business Practice Location Address Fax Number:
760-228-3223
Provider Enumeration Date:
04/07/2012