Provider First Line Business Practice Location Address:
17995 HIGHWAY 18, SUITE 3
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-961-2225
Provider Business Practice Location Address Fax Number:
760-961-2233
Provider Enumeration Date:
01/13/2007