Provider First Line Business Practice Location Address:
20162 HY 18
Provider Second Line Business Practice Location Address:
STE L
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-946-1466
Provider Business Practice Location Address Fax Number:
760-946-1956
Provider Enumeration Date:
11/09/2006