Provider First Line Business Practice Location Address:
29099 HOSPITAL ROAD STE 204B
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:
92352-9235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-337-7771
Provider Business Practice Location Address Fax Number:
909-337-5353
Provider Enumeration Date:
12/11/2006