Provider First Line Business Practice Location Address:
10587 PARADISE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUGH AND READY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95975-9769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-432-8337
Provider Business Practice Location Address Fax Number:
530-432-8337
Provider Enumeration Date:
11/15/2006