Provider First Line Business Practice Location Address:
6540 WENTWORTH SPRINGS RD
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:
95634-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-333-8300
Provider Business Practice Location Address Fax Number:
530-333-8303
Provider Enumeration Date:
03/15/2024