Provider First Line Business Practice Location Address:
9385 OLD STATE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95658-9597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-672-8470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2012