Provider First Line Business Practice Location Address:
18077 HIGHWAY 18 STE A
Provider Second Line Business Practice Location Address:
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:
760-515-6141
Provider Business Practice Location Address Fax Number:
760-515-6434
Provider Enumeration Date:
03/20/2007