Provider First Line Business Practice Location Address:
81106 US HIGHWAY 111 STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-775-7779
Provider Business Practice Location Address Fax Number:
760-775-7734
Provider Enumeration Date:
11/16/2006