Provider First Line Business Practice Location Address:
22475 LONGVUE RD
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:
92241-9271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-898-2491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2026