Provider First Line Business Practice Location Address:
6380 SPLIT ROCK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWENTYNINE PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-367-6028
Provider Business Practice Location Address Fax Number:
760-367-2178
Provider Enumeration Date:
12/05/2006