Provider First Line Business Practice Location Address:
60805 29 PALMS HWY
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:
92252-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-974-5990
Provider Business Practice Location Address Fax Number:
760-262-3937
Provider Enumeration Date:
01/05/2023