Provider First Line Business Practice Location Address:
2082 PENNINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95953-2599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-695-5435
Provider Business Practice Location Address Fax Number:
530-695-5443
Provider Enumeration Date:
09/11/2017