Provider First Line Business Practice Location Address:
3710 STATE HIGHWAY 45
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95932-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-458-5501
Provider Business Practice Location Address Fax Number:
530-458-8660
Provider Enumeration Date:
07/26/2006