Provider First Line Business Practice Location Address:
121 S CHINA LAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RIDGECREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93555-4049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-375-9399
Provider Business Practice Location Address Fax Number:
760-375-9499
Provider Enumeration Date:
10/23/2006