Provider First Line Business Practice Location Address:
15290-B BEAR VALLEY ROAD (AT BALSAM AVE)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-951-7777
Provider Business Practice Location Address Fax Number:
760-951-1582
Provider Enumeration Date:
12/11/2006