Provider First Line Business Practice Location Address:
18387 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITES 1 & 2
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-0111
Provider Business Practice Location Address Fax Number:
760-242-0877
Provider Enumeration Date:
11/09/2011