Provider First Line Business Practice Location Address:
6065 STATE HIGHWAY 193
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95634-9623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-333-2548
Provider Business Practice Location Address Fax Number:
530-748-0340
Provider Enumeration Date:
12/14/2005