Provider First Line Business Practice Location Address:
20601 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
BLD 142
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-3567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-559-2485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007