Provider First Line Business Practice Location Address:
12901 E HIGHWAY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARLAKE OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95423-9326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-613-0098
Provider Business Practice Location Address Fax Number:
707-703-5792
Provider Enumeration Date:
01/08/2024