Provider First Line Business Practice Location Address:
8233 RAINBOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGS BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-546-3297
Provider Business Practice Location Address Fax Number:
530-546-4806
Provider Enumeration Date:
04/30/2007