Provider First Line Business Practice Location Address:
19059 BEAR VALLEY RD.
Provider Second Line Business Practice Location Address:
#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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-515-5000
Provider Business Practice Location Address Fax Number:
760-240-3848
Provider Enumeration Date:
11/29/2011