Provider First Line Business Practice Location Address:
10202 SPADE SPRING CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUA DULCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91390-5603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-268-8816
Provider Business Practice Location Address Fax Number:
661-268-8837
Provider Enumeration Date:
02/07/2013