Provider First Line Business Practice Location Address:
5796 CLARK RD
Provider Second Line Business Practice Location Address:
STE 8
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969-5152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-877-0244
Provider Business Practice Location Address Fax Number:
530-877-0241
Provider Enumeration Date:
06/23/2005