Provider First Line Business Practice Location Address:
19181 TOWN CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92308-8989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-241-8000
Provider Business Practice Location Address Fax Number:
760-962-8021
Provider Enumeration Date:
01/26/2011