Provider First Line Business Practice Location Address:
20115 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-8881
Provider Business Practice Location Address Fax Number:
760-242-1382
Provider Enumeration Date:
09/26/2006