Provider First Line Business Practice Location Address:
13692 APPLE VALLEY RD
Provider Second Line Business Practice Location Address:
# 170
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:
760-961-1919
Provider Business Practice Location Address Fax Number:
760-961-1907
Provider Enumeration Date:
08/28/2006