Provider First Line Business Practice Location Address:
1151 SILVER SPUR WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLUMAS LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95961-9112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-315-6833
Provider Business Practice Location Address Fax Number:
530-491-4083
Provider Enumeration Date:
04/17/2022