Provider First Line Business Practice Location Address:
73221 HIGHWAY 111
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92260-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-773-2179
Provider Business Practice Location Address Fax Number:
760-773-2810
Provider Enumeration Date:
08/11/2006