Provider First Line Business Practice Location Address:
35591 E KINGS CANYON RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SQUAW VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93675-9651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-903-7221
Provider Business Practice Location Address Fax Number:
559-557-4596
Provider Enumeration Date:
09/22/2010