Provider First Line Business Practice Location Address:
31730 AVENIDA DEL PADRE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-321-8000
Provider Business Practice Location Address Fax Number:
760-321-8002
Provider Enumeration Date:
11/25/2014