Provider First Line Business Practice Location Address:
180 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKWOURTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96129-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-832-1008
Provider Business Practice Location Address Fax Number:
530-832-5828
Provider Enumeration Date:
04/16/2013