Provider First Line Business Practice Location Address:
6480 PENTZ RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969-3672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-877-4983
Provider Business Practice Location Address Fax Number:
530-877-8621
Provider Enumeration Date:
02/09/2007