Provider First Line Business Practice Location Address:
19333 BEAR VALLEY 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:
92308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-241-6666
Provider Business Practice Location Address Fax Number:
760-247-4368
Provider Enumeration Date:
01/19/2007