Provider First Line Business Practice Location Address:
15500 BUBBLING WELLS RD SPC 88
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:
92240-7059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-678-5151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2026