Provider First Line Business Practice Location Address:
12561 PALM DR STE D
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:
92240-4521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-917-2101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2025