Provider First Line Business Practice Location Address:
500 S. 7TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BARSTOW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92311-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-252-2168
Provider Business Practice Location Address Fax Number:
760-252-2168
Provider Enumeration Date:
08/10/2006