Provider First Line Business Practice Location Address:
18930 US HIGHWAY 18 STE 103
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:
92307-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-896-1358
Provider Business Practice Location Address Fax Number:
760-645-6202
Provider Enumeration Date:
12/13/2007