Provider First Line Business Practice Location Address:
17995 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-810-4080
Provider Business Practice Location Address Fax Number:
760-810-4036
Provider Enumeration Date:
10/14/2011