Provider First Line Business Practice Location Address:
19190 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-7753
Provider Business Practice Location Address Fax Number:
760-946-1122
Provider Enumeration Date:
12/22/2006