Provider First Line Business Practice Location Address:
5500 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:
95969-5106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-872-5500
Provider Business Practice Location Address Fax Number:
530-872-7423
Provider Enumeration Date:
06/08/2005