Provider First Line Business Practice Location Address:
14080 PALM DR.
Provider Second Line Business Practice Location Address:
STE E
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:
760-288-7878
Provider Business Practice Location Address Fax Number:
760-288-7474
Provider Enumeration Date:
11/03/2010