Provider First Line Business Practice Location Address:
801 GOLF CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ALMANOR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-259-2306
Provider Business Practice Location Address Fax Number:
530-259-3707
Provider Enumeration Date:
01/22/2007