Provider First Line Business Practice Location Address:
184 HOT SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95947-9747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-284-7191
Provider Business Practice Location Address Fax Number:
530-284-6696
Provider Enumeration Date:
02/11/2006