Provider First Line Business Practice Location Address:
1870 KENNETH WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95993-8917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-788-5015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2025