Provider First Line Business Practice Location Address:
34590 COUNTY LINE RD
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
YUCAIPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92399-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-795-4255
Provider Business Practice Location Address Fax Number:
909-795-4438
Provider Enumeration Date:
01/28/2011