Provider First Line Business Practice Location Address:
3080 NORTH LAKE BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHOE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-831-7204
Provider Business Practice Location Address Fax Number:
775-831-1777
Provider Enumeration Date:
03/26/2010