Provider First Line Business Practice Location Address:
2920 CLARK RD SPC 16B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTTE VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95965-9140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-219-1462
Provider Business Practice Location Address Fax Number:
775-306-4317
Provider Enumeration Date:
03/18/2011