Provider First Line Business Practice Location Address:
16192 SISKIYOU RD
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-946-2500
Provider Business Practice Location Address Fax Number:
760-946-2800
Provider Enumeration Date:
07/27/2006