Provider First Line Business Practice Location Address:
18144 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-278-9477
Provider Business Practice Location Address Fax Number:
760-813-7004
Provider Enumeration Date:
03/08/2016