Provider First Line Business Practice Location Address:
18408 CHAPARRAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95946-9230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-673-8861
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2026