Provider First Line Business Practice Location Address:
73080 20TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESERT HOT SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92241-7862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-264-5493
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2026