Provider First Line Business Practice Location Address:
18231 US HIGHWAY 18 STE 4
Provider Second Line Business Practice Location Address:
SUITE #4
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:
442-242-0929
Provider Business Practice Location Address Fax Number:
442-219-2304
Provider Enumeration Date:
01/08/2014