Provider First Line Business Practice Location Address:
18152 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-2273
Provider Business Practice Location Address Fax Number:
909-583-9827
Provider Enumeration Date:
08/14/2009