Provider First Line Business Practice Location Address:
18523 CORWIN RD STE H
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:
92307-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-3000
Provider Business Practice Location Address Fax Number:
760-242-1802
Provider Enumeration Date:
01/31/2012