Provider First Line Business Practice Location Address:
19071 BEAR VALLEY RD.
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92308-6709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-240-7273
Provider Business Practice Location Address Fax Number:
760-240-9757
Provider Enumeration Date:
02/13/2008