Provider First Line Business Practice Location Address:
34481 DATE PALM DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-6842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-324-5071
Provider Business Practice Location Address Fax Number:
760-324-5877
Provider Enumeration Date:
11/09/2006