Provider First Line Business Practice Location Address:
12350 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:
92399-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-797-9191
Provider Business Practice Location Address Fax Number:
909-797-4784
Provider Enumeration Date:
09/12/2006