Provider First Line Business Practice Location Address:
112 E 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTURAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96101-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-249-5352
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2010