Provider First Line Business Practice Location Address:
927 ARMORY RD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
BARSTOW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-252-4488
Provider Business Practice Location Address Fax Number:
760-252-7700
Provider Enumeration Date:
07/31/2006