Provider First Line Business Practice Location Address:
14715 EAST HWY 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARLAKE OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95423-0366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-988-1800
Provider Business Practice Location Address Fax Number:
707-274-2170
Provider Enumeration Date:
06/10/2024