Provider First Line Business Practice Location Address:
44255 HIGHWAY 299 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCARTHUR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96056-8571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-336-6142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2020