Provider First Line Business Practice Location Address:
18888 HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE 106
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-961-5370
Provider Business Practice Location Address Fax Number:
760-961-5354
Provider Enumeration Date:
01/22/2026