Provider First Line Business Practice Location Address:
3936 PHELAN RD
Provider Second Line Business Practice Location Address:
SUITE F1
Provider Business Practice Location Address City Name:
PHELAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92371-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-868-6622
Provider Business Practice Location Address Fax Number:
760-868-2505
Provider Enumeration Date:
05/24/2006