Provider First Line Business Practice Location Address:
34636 COUNTY LINE RD STE 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCAIPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92399-5393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-795-2585
Provider Business Practice Location Address Fax Number:
909-795-0046
Provider Enumeration Date:
01/08/2007