Provider First Line Business Practice Location Address:
18031 OUTER HWY 18 STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-515-1600
Provider Business Practice Location Address Fax Number:
760-515-1700
Provider Enumeration Date:
01/02/2026