Provider First Line Business Practice Location Address: 
26400 DARTMOUTH ST
    Provider Second Line Business Practice Location Address: 
HEMET ACADEMY
    Provider Business Practice Location Address City Name: 
HEMET
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92544-6302
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
951-294-5882
    Provider Business Practice Location Address Fax Number: 
951-294-5806
    Provider Enumeration Date: 
09/06/2012