Provider First Line Business Practice Location Address:
10619 SWEDE CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALO CEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96073-9741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-921-3982
Provider Business Practice Location Address Fax Number:
530-768-2277
Provider Enumeration Date:
10/12/2026