Provider First Line Business Practice Location Address:
18564 HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE# 105
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-7777
Provider Business Practice Location Address Fax Number:
909-563-8447
Provider Enumeration Date:
01/08/2008