Provider First Line Business Practice Location Address:
378 W CORTEZ RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-325-4146
Provider Business Practice Location Address Fax Number:
760-325-4114
Provider Enumeration Date:
07/29/2010