Provider First Line Business Practice Location Address:
2145 EAST TAHQUITZ CANYON WAY
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-323-2517
Provider Business Practice Location Address Fax Number:
760-323-1627
Provider Enumeration Date:
09/07/2006