Provider First Line Business Practice Location Address:
35758 DATE PALM DR
Provider Second Line Business Practice Location Address:
B-5
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-6653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-328-2115
Provider Business Practice Location Address Fax Number:
760-202-1333
Provider Enumeration Date:
07/14/2006