Provider First Line Business Practice Location Address:
66563 5TH STREET
Provider Second Line Business Practice Location Address:
UNIT C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-685-0041
Provider Business Practice Location Address Fax Number:
949-200-4512
Provider Enumeration Date:
12/04/2024