Provider First Line Business Practice Location Address:
34500 MONTEREY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92211-2089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-321-8124
Provider Business Practice Location Address Fax Number:
760-324-1069
Provider Enumeration Date:
02/09/2007