Provider First Line Business Practice Location Address:
64236 SECOND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAPPY CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96039-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-493-5257
Provider Business Practice Location Address Fax Number:
530-493-5270
Provider Enumeration Date:
01/05/2009