Provider First Line Business Practice Location Address:
495 NORTH LAKE BLVD - 96145
Provider Second Line Business Practice Location Address:
STE 270
Provider Business Practice Location Address City Name:
TAHOE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96145-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-583-5546
Provider Business Practice Location Address Fax Number:
530-583-3559
Provider Enumeration Date:
03/05/2015