Provider First Line Business Practice Location Address:
13943 RIVER'S EDGE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-952-1266
Provider Business Practice Location Address Fax Number:
760-245-3210
Provider Enumeration Date:
03/16/2026