Provider First Line Business Practice Location Address:
1849 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-263-6036
Provider Business Practice Location Address Fax Number:
707-263-6036
Provider Enumeration Date:
11/28/2006