Provider First Line Business Practice Location Address:
29099 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352-2993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-337-4310
Provider Business Practice Location Address Fax Number:
909-336-5937
Provider Enumeration Date:
08/22/2006