Provider First Line Business Practice Location Address:
20601 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE 153
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-3567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-953-5800
Provider Business Practice Location Address Fax Number:
760-961-8500
Provider Enumeration Date:
08/19/2008