Provider First Line Business Practice Location Address:
29101 HOSPITAL RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-796-4006
Provider Business Practice Location Address Fax Number:
888-796-4006
Provider Enumeration Date:
10/01/2007