Provider First Line Business Practice Location Address:
1100 E AMADO RD UNIT 12B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-0017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-534-2999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2026