Provider First Line Business Practice Location Address:
511 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ETNA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96027-0610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-467-5335
Provider Business Practice Location Address Fax Number:
530-467-5111
Provider Enumeration Date:
10/17/2006