Provider First Line Business Practice Location Address:
18400 US HIGHWAY 18 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92307-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-588-2190
Provider Business Practice Location Address Fax Number:
949-588-2199
Provider Enumeration Date:
12/01/2011