Provider First Line Business Practice Location Address:
176 HOT SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95947-9747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-284-6116
Provider Business Practice Location Address Fax Number:
530-350-2595
Provider Enumeration Date:
01/18/2007