Provider First Line Business Practice Location Address:
6448 HALLEE RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOSHUA TREE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92252-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-366-3653
Provider Business Practice Location Address Fax Number:
760-366-3674
Provider Enumeration Date:
08/20/2006