Provider First Line Business Practice Location Address:
100 VETERANS PKWY
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:
92311-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-252-6200
Provider Business Practice Location Address Fax Number:
760-252-6333
Provider Enumeration Date:
09/12/2005