Provider First Line Business Practice Location Address:
11943 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT JONES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-468-4100
Provider Business Practice Location Address Fax Number:
530-468-4104
Provider Enumeration Date:
07/11/2006