Provider First Line Business Practice Location Address:
18 COUNTY CENTER DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-538-7705
Provider Business Practice Location Address Fax Number:
530-538-2161
Provider Enumeration Date:
11/29/2006