Provider First Line Business Practice Location Address:
18564 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE 303
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:
760-242-4111
Provider Business Practice Location Address Fax Number:
760-242-4555
Provider Enumeration Date:
01/31/2012