Provider First Line Business Practice Location Address:
410 MAIN STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-284-7990
Provider Business Practice Location Address Fax Number:
530-284-6612
Provider Enumeration Date:
04/12/2007