Provider First Line Business Practice Location Address:
704 MILL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOYALTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96118-0265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-993-6714
Provider Business Practice Location Address Fax Number:
530-993-6759
Provider Enumeration Date:
06/12/2007