Provider First Line Business Practice Location Address:
SANFORD MINTZ PHD 53423 AVENIDA DIAZ
Provider Second Line Business Practice Location Address:
LA QUINTA
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-663-0010
Provider Business Practice Location Address Fax Number:
305-663-4212
Provider Enumeration Date:
03/29/2007