Provider First Line Business Practice Location Address:
19432 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-980-4326
Provider Business Practice Location Address Fax Number:
888-822-1618
Provider Enumeration Date:
09/16/2020