Provider First Line Business Practice Location Address:
515 DESERT WAY
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:
92264-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-325-7158
Provider Business Practice Location Address Fax Number:
760-327-4283
Provider Enumeration Date:
08/07/2007