Provider First Line Business Practice Location Address:
64100 HILLSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAPPY CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-493-1650
Provider Business Practice Location Address Fax Number:
530-493-5364
Provider Enumeration Date:
10/21/2026