Provider First Line Business Practice Location Address:
42296 VALLEY CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBERRY SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92365-9663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-954-4041
Provider Business Practice Location Address Fax Number:
760-254-3286
Provider Enumeration Date:
07/18/2006