Provider First Line Business Practice Location Address:
56299 29 PALMS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-369-1743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2013