Provider First Line Business Practice Location Address:
1301 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARSTOW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92311-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-255-3200
Provider Business Practice Location Address Fax Number:
760-255-3210
Provider Enumeration Date:
12/28/2011