Provider First Line Business Practice Location Address:
6283 CLARK RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-872-5800
Provider Business Practice Location Address Fax Number:
530-872-5804
Provider Enumeration Date:
08/24/2006