Provider First Line Business Practice Location Address:
29101 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352-9706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-336-9715
Provider Business Practice Location Address Fax Number:
909-336-5751
Provider Enumeration Date:
08/13/2006