Provider First Line Business Practice Location Address:
2314 INYO ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOJAVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93501-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-824-1872
Provider Business Practice Location Address Fax Number:
661-824-2877
Provider Enumeration Date:
08/12/2014