Provider First Line Business Practice Location Address:
34950 DATE PALM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-6833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-324-2525
Provider Business Practice Location Address Fax Number:
760-321-9604
Provider Enumeration Date:
11/17/2010