Provider First Line Business Practice Location Address:
81735 US HIGHWAY 111
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201-0713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-650-1212
Provider Business Practice Location Address Fax Number:
602-650-1616
Provider Enumeration Date:
03/11/2015