Provider First Line Business Practice Location Address:
16395 AVENIDA ATEZADA
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:
92240-9097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-308-8549
Provider Business Practice Location Address Fax Number:
503-974-0957
Provider Enumeration Date:
12/23/2015