Provider First Line Business Practice Location Address:
18484 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-995-5134
Provider Business Practice Location Address Fax Number:
888-843-0969
Provider Enumeration Date:
07/27/2010