Provider First Line Business Practice Location Address:
1475 PADDINGTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLUMAS LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95961-9129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-789-0689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2025