Provider First Line Business Practice Location Address:
11219 N HIGHWAY 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT JONES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96032-9731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-468-5766
Provider Business Practice Location Address Fax Number:
530-468-2023
Provider Enumeration Date:
05/08/2008