Provider First Line Business Practice Location Address:
6696 CLARK RD
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:
95969-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-872-6400
Provider Business Practice Location Address Fax Number:
530-877-5073
Provider Enumeration Date:
03/31/2008