Provider First Line Business Practice Location Address:
22633 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
# A
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-247-7148
Provider Business Practice Location Address Fax Number:
760-247-7114
Provider Enumeration Date:
06/11/2012