Provider First Line Business Practice Location Address:
484 EDGEMOOR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG BEAR LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-273-3493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2025