Provider First Line Business Practice Location Address:
18031 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
STE. E
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-2338
Provider Business Practice Location Address Fax Number:
760-242-1025
Provider Enumeration Date:
10/26/2006