Provider First Line Business Practice Location Address:
30156 LAMPLIGHTER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENIFEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92584-6930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-331-4253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2026