Provider First Line Business Practice Location Address:
7598 HWY 89
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAEAGLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-832-6500
Provider Business Practice Location Address Fax Number:
530-832-1105
Provider Enumeration Date:
06/24/2005