Provider First Line Business Practice Location Address:
9000 LARKIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95953-9599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-695-8020
Provider Business Practice Location Address Fax Number:
530-695-1843
Provider Enumeration Date:
07/19/2005