Provider First Line Business Practice Location Address:
500 SOUTH PALM CANYON DRIVE
Provider Second Line Business Practice Location Address:
STE 203
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-323-2524
Provider Business Practice Location Address Fax Number:
760-323-2528
Provider Enumeration Date:
02/23/2006