Provider First Line Business Practice Location Address:
3102 EAST HIGHLAND AVENUE
Provider Second Line Business Practice Location Address:
PATTON STATE HOSPITAL
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:
909-425-6519
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006