Provider First Line Business Practice Location Address:
116894 SOUTH HIGHLAND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-651-4700
Provider Business Practice Location Address Fax Number:
909-651-4737
Provider Enumeration Date:
10/30/2026