Provider First Line Business Practice Location Address:
73625 HIGHWAY 111 STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92260-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-674-8114
Provider Business Practice Location Address Fax Number:
760-674-8115
Provider Enumeration Date:
05/01/2007