Provider First Line Business Practice Location Address: 
3102 E. HIGHLAND AVENUE
    Provider Second Line Business Practice Location Address: 
MEDICAL STAFF OFFICE
    Provider Business Practice Location Address City Name: 
PATTON
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
92369
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
909-425-7000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/19/2009