Provider First Line Business Practice Location Address:
30400 NORTHWOOD RD
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:
92241-5187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-238-0710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2023