Provider First Line Business Practice Location Address:
5404 PENNINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95953-9541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-632-8219
Provider Business Practice Location Address Fax Number:
916-500-0609
Provider Enumeration Date:
10/21/2024