Provider First Line Business Practice Location Address:
645 OLD MAMMOTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAMMOTH LAKES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-227-3525
Provider Business Practice Location Address Fax Number:
760-544-6106
Provider Enumeration Date:
07/19/2006