Provider First Line Business Practice Location Address:
31020 CA-3
Provider Second Line Business Practice Location Address:
BLDG 34
Provider Business Practice Location Address City Name:
WEAVERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-623-5533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2025