Provider First Line Business Practice Location Address:
12840 CACTUS DRIVE
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:
92240-4514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-288-0238
Provider Business Practice Location Address Fax Number:
760-329-6348
Provider Enumeration Date:
09/07/2023