Provider First Line Business Practice Location Address:
475-750 RICE CANYON RD.
Provider Second Line Business Practice Location Address:
HIGH DESERT STATE PRISON
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-5100
Provider Business Practice Location Address Fax Number:
530-251-5087
Provider Enumeration Date:
12/24/2007