Provider First Line Business Practice Location Address:
1028 LEMON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95901-5133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-632-8219
Provider Business Practice Location Address Fax Number:
916-500-0609
Provider Enumeration Date:
04/17/2026