Provider First Line Business Practice Location Address:
20251 US HIGHWAY 18
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:
92307-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-946-2430
Provider Business Practice Location Address Fax Number:
760-946-2030
Provider Enumeration Date:
01/19/2018