Provider First Line Business Practice Location Address:
PO BOX 580
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SAN JUAN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95960-0580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-263-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2026