Provider First Line Business Practice Location Address:
1345 LADY FERN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLUMAS LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-709-5673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2008