Provider First Line Business Practice Location Address:
47-915 OASIS STREET, UNIT C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-989-4900
Provider Business Practice Location Address Fax Number:
760-863-0351
Provider Enumeration Date:
09/14/2009