Provider First Line Business Practice Location Address:
3335 APRICOT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95953-2293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-649-6951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2026