Provider First Line Business Practice Location Address:
29099 HOSPITAL RD
Provider Second Line Business Practice Location Address:
STE 112
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-337-3661
Provider Business Practice Location Address Fax Number:
909-337-3570
Provider Enumeration Date:
01/23/2009