Provider First Line Business Practice Location Address:
19195 OUTER HIGHWAY 18
Provider Second Line Business Practice Location Address:
101
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:
760-242-5300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2010