Provider First Line Business Practice Location Address:
18231 HAPPY TRAILS HWY
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-946-9032
Provider Business Practice Location Address Fax Number:
760-946-9034
Provider Enumeration Date:
10/16/2006