Provider First Line Business Practice Location Address:
22576 SOUTH RD
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:
92307-1933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-565-8348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2009