Provider First Line Business Practice Location Address:
34480 COUNTY LINE RD SPC 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCAIPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92399-5316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-709-2922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2025