Provider First Line Business Practice Location Address:
71757 29 PALMS HWY STE C
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:
92277-2085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-367-1100
Provider Business Practice Location Address Fax Number:
760-367-2033
Provider Enumeration Date:
01/17/2007