Provider First Line Business Practice Location Address:
29099 HOSPITAL ROAD, SUITE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352-4816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-744-9451
Provider Business Practice Location Address Fax Number:
909-744-9453
Provider Enumeration Date:
04/16/2012