Provider First Line Business Practice Location Address:
42215 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92211-8032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-772-3553
Provider Business Practice Location Address Fax Number:
760-772-3551
Provider Enumeration Date:
04/04/2012