Provider First Line Business Practice Location Address:
12526 PALM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESERT HOT SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92240-4574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-440-6220
Provider Business Practice Location Address Fax Number:
951-244-5542
Provider Enumeration Date:
09/18/2026