Provider First Line Business Practice Location Address:
6032 CLARK RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-877-3808
Provider Business Practice Location Address Fax Number:
530-877-5764
Provider Enumeration Date:
01/17/2007