Provider First Line Business Practice Location Address:
98821 HIGHWAY 96
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMES BAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-469-3373
Provider Business Practice Location Address Fax Number:
530-469-3390
Provider Enumeration Date:
02/04/2025