Provider First Line Business Practice Location Address:
16124 KASOTA RD
Provider Second Line Business Practice Location Address:
STE A & B
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-2099
Provider Business Practice Location Address Fax Number:
760-242-5065
Provider Enumeration Date:
11/02/2006