Provider First Line Business Practice Location Address:
18419 US HIGHWAY 18 STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-946-9955
Provider Business Practice Location Address Fax Number:
760-946-9409
Provider Enumeration Date:
07/28/2026