Provider First Line Business Practice Location Address:
2810 LAKE FOREST RD.
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-232-4554
Provider Business Practice Location Address Fax Number:
530-582-6278
Provider Enumeration Date:
12/23/2010