Provider First Line Business Practice Location Address:
82262 VALENCIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-347-6000
Provider Business Practice Location Address Fax Number:
760-755-6828
Provider Enumeration Date:
09/07/2005