Provider First Line Business Practice Location Address:
2776 MINERS FLAT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95634-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-333-4658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007