Provider First Line Business Practice Location Address:
80904 COLUMBIA 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:
92201-4974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-229-9570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2026