Provider First Line Business Practice Location Address:
5910 CLARK RD
Provider Second Line Business Practice Location Address:
SUITE W
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:
530-877-4264
Provider Business Practice Location Address Fax Number:
530-872-5970
Provider Enumeration Date:
12/27/2006