Provider First Line Business Practice Location Address:
20236 NOWATA RD
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:
92307-5634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-240-0333
Provider Business Practice Location Address Fax Number:
760-240-7588
Provider Enumeration Date:
12/04/2006