Provider First Line Business Practice Location Address:
558 S PASEO DOROTEA STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92264-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-423-4000
Provider Business Practice Location Address Fax Number:
760-318-8103
Provider Enumeration Date:
08/31/2006