Provider First Line Business Practice Location Address:
68733 PEREZ RD STE C14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-7223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-992-5227
Provider Business Practice Location Address Fax Number:
760-992-5227
Provider Enumeration Date:
12/31/2005