Provider First Line Business Practice Location Address:
6009 PENTZ RD
Provider Second Line Business Practice Location Address:
BLDG A
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969-5542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-899-2244
Provider Business Practice Location Address Fax Number:
530-899-9331
Provider Enumeration Date:
08/30/2006