Provider First Line Business Practice Location Address:
65 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WEAVERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-355-3081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2009