Provider First Line Business Practice Location Address:
121 SOUTH 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE B
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:
760-256-8791
Provider Business Practice Location Address Fax Number:
760-256-8710
Provider Enumeration Date:
09/20/2006