Provider First Line Business Practice Location Address:
25323 LEE 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:
96055-9746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-642-7800
Provider Business Practice Location Address Fax Number:
530-364-2233
Provider Enumeration Date:
12/25/2025