Provider First Line Business Practice Location Address:
20258 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
STE 450
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-6197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-961-8125
Provider Business Practice Location Address Fax Number:
760-949-1236
Provider Enumeration Date:
11/30/2010