Provider First Line Business Practice Location Address:
136 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96094-2574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-938-3045
Provider Business Practice Location Address Fax Number:
530-938-3045
Provider Enumeration Date:
08/26/2008