Provider First Line Business Practice Location Address:
18484 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
STE 280B
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-946-4619
Provider Business Practice Location Address Fax Number:
760-946-2360
Provider Enumeration Date:
12/21/2006