Provider First Line Business Practice Location Address:
72210 HIGHWAY 111
Provider Second Line Business Practice Location Address:
STE. E-1
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92260-2782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-341-3009
Provider Business Practice Location Address Fax Number:
760-341-3070
Provider Enumeration Date:
09/27/2006