Provider First Line Business Practice Location Address:
34-950 DATE PALM DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-6833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-321-1453
Provider Business Practice Location Address Fax Number:
760-324-6656
Provider Enumeration Date:
11/17/2006