Provider First Line Business Practice Location Address:
945 ARMORY RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARSTOW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92311-5478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-252-7518
Provider Business Practice Location Address Fax Number:
760-252-7510
Provider Enumeration Date:
08/19/2005