Provider First Line Business Practice Location Address:
780 E WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531-8397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-322-4550
Provider Business Practice Location Address Fax Number:
775-322-4956
Provider Enumeration Date:
07/26/2019