Provider First Line Business Practice Location Address:
42 STATE ROUTE 26
Provider Second Line Business Practice Location Address:
SUITE #B
Provider Business Practice Location Address City Name:
VALLEY SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95252-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-588-0421
Provider Business Practice Location Address Fax Number:
916-588-0421
Provider Enumeration Date:
04/06/2026