Provider First Line Business Practice Location Address:
9461 DESCHUTES RD STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO CEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96073-9761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-547-4277
Provider Business Practice Location Address Fax Number:
530-547-4284
Provider Enumeration Date:
03/01/2007