Provider First Line Business Practice Location Address:
1329 HWY 2
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
WRIGHTWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-249-5411
Provider Business Practice Location Address Fax Number:
760-249-3561
Provider Enumeration Date:
10/26/2006