Provider First Line Business Practice Location Address:
1020 EAST BROADWAY STREET
Provider Second Line Business Practice Location Address:
NEEDLES TOWN CENTER
Provider Business Practice Location Address City Name:
NEEDLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92363-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-326-2944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006