Provider First Line Business Practice Location Address:
58501 29 PALMS HWY
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:
92284-5765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-7551
Provider Business Practice Location Address Fax Number:
760-365-6932
Provider Enumeration Date:
07/16/2006