Provider First Line Business Practice Location Address:
30365 HIGHWAY 299
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-337-6214
Provider Business Practice Location Address Fax Number:
530-337-6215
Provider Enumeration Date:
05/03/2007