Provider First Line Business Practice Location Address:
12197 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCAIPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92399-4332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-797-2104
Provider Business Practice Location Address Fax Number:
909-797-6724
Provider Enumeration Date:
01/20/2011