Provider First Line Business Practice Location Address:
132 MEE THEE-UH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. BIDWELL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-279-6115
Provider Business Practice Location Address Fax Number:
530-279-6100
Provider Enumeration Date:
09/08/2006