Provider First Line Business Practice Location Address:
4309 STAGECOACH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNSMUIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-235-4138
Provider Business Practice Location Address Fax Number:
530-378-2453
Provider Enumeration Date:
09/17/2012