Provider First Line Business Practice Location Address:
18522 US HIGHWAY 18
Provider Second Line Business Practice Location Address:
STE. 208
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-242-9262
Provider Business Practice Location Address Fax Number:
760-242-9264
Provider Enumeration Date:
05/03/2006