Provider First Line Business Practice Location Address:
5898 CLARK RD.
Provider Second Line Business Practice Location Address:
STE. 1
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-876-8484
Provider Business Practice Location Address Fax Number:
530-876-8444
Provider Enumeration Date:
09/06/2012