Provider First Line Business Practice Location Address:
25127 S CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS MOLINOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96055-9783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-576-3100
Provider Business Practice Location Address Fax Number:
530-576-3101
Provider Enumeration Date:
07/28/2005