Provider First Line Business Practice Location Address:
12218 APPLE VALLEY RD BLDG 1
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92308-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-300-3678
Provider Business Practice Location Address Fax Number:
760-247-6254
Provider Enumeration Date:
11/26/2007