Provider First Line Business Practice Location Address:
12308 MOUNTAIN MESA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ISABELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-327-4030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2024