Provider First Line Business Practice Location Address:
1916 DESOTO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92363-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-326-1256
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2010