Provider First Line Business Practice Location Address:
2390 BASS LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESCUE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95672-9571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-672-4804
Provider Business Practice Location Address Fax Number:
530-672-1889
Provider Enumeration Date:
01/02/2007