Provider First Line Business Practice Location Address:
18484 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-2341
Provider Business Practice Location Address Fax Number:
760-242-2869
Provider Enumeration Date:
10/11/2006