Provider First Line Business Practice Location Address:
12143 NAVAJO ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-240-1144
Provider Business Practice Location Address Fax Number:
760-256-8227
Provider Enumeration Date:
11/24/2006