Provider First Line Business Practice Location Address:
300 H 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:
92363-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-326-4590
Provider Business Practice Location Address Fax Number:
760-326-3154
Provider Enumeration Date:
11/15/2012